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LIBRARY  OF 

Dr.  carl  F.  W.  BODECKER 

1846-1912 

The  gift  of 

Dr.  Henry  and  Dr.  Charles  Bodecker 

1929 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/irregularitiesofOOtalb 


IRREGULARITIES 


OF 


THE  TEETH 


TALBOT 


^fmM-^^tA^ 


IRREGULARITIESoftheTEETH 


AND 


THEIR  TREATMENT 

BY 

EUGENE  S.  Talbot,  M.  S.,  D.  D.  S.,  M.  D.,  LL.D. 

Professor  of  Stomatology,  Illinois  Medical  College.  Honorary  President  of  the 
Dental  Section  of  the  Tenth  International  Medical  Congress,  Berlin.  1890; 
Honorary  President  of  the  Dental  Section  of  the  Twelfth  International  Medi- 
cal Congress,  Moscow,  1897;  Member  of  the  Thirteenth  International  Medical 
Congress,  Paris,  1900;  Member  of  the  Fourteenth  International  Medical  Con- 
gress, Madrid,  1903;  Honorary  Secretary  of  the  Pan-American  Medical  Con- 
gress, Washington,  1893;  Honorary  Secretary  of  Pan-American  Medical 
Congress,  Havana.  Cuba,  1901;  Member  of  the  American  Medical  Association; 
Fellow  of  the  Chicago  Academy  of  Medicine;  Member  of  the  Chicago  Pathologi- 
cal Society;  Member  of  the  Chicago  Medical  Society;  Secretary  of  the  Section 
on  Stomatology  of  the  American  Medical  Association;  Member  of  the  Chicago 
Academy  of  Sciences;  Fellow  American  Academy  of  Dental  Science,  Boston; 
Honorary  Member  of  the  Odontologischen  Gesellschaft,  Berlin,  Germany; 
Membre  Honoraire  de  I'Association  Generale  des  Dentistes  de  France; 
Honorary  Member  Sociedad  Odontologia  Espanola;  Corresponding  Member  of 
the  Dansk-Tandlaegeforening;  Author  of  "Irregularities  of  the  Teeth  and  Their 
Treatment";  Author  of  "Chart  of  Typical  Forms  of  Constitutional  Irregulari- 
ties of  the  Teeth";  Author  of  "Etiology  of  Osseous  Deformities  of  the  Head. 
Face.  Jaws  and  Teeth":  Author  of  "Degeneracy;  Its  Causes,  Signs,  and 
Results";  Author  of  "Interstitial  Gingivitis;  or,  So-called  Pyorrhoea  Alveolaris," 
Etc..  Etc. 


FIFTH  EDITION 


WITH  581  ILLUSTRATIONS 


PHILADELPHIA 
THE  S.  S.  WHITE  DENTAL  MANUFACTURING  CO. 

1903. 


ENTERED   ACCORDING  TO  ACT   OF  CONGRESS 
IN   THE  YEAR   1903.    BY 

EUGENE    S.    TALBOT, 

IN  THE  OFFICE  OF  THE  LIBRARIAN   OF  CONGRESS 
AT   WASHINGTON,  D.  C. 


HAMMOND    PRCS3 

W.    B.     CONKEY     COMPANY 

CHICAQO 


DR.   N.   S.   DAVIS 


T^re 


WHO  BY  TTTE  foundation    OF   THE    AMERICAN    MEDICAL 

ASSOCIATION    HAS   ELEVATED  THE  STATUS  OF 

DENTISTRY   AND    ALL    THE    MEDICAL 

SCIENCES,  THIS  WORK  IS 


PREFACE  TO  FIFTH  EDITION. 


Since  the  fourth  edition  of  this  work  appeared,  practically 
no  modifications  of  the  general  principles  therein  outlined 
have  been  made.  The  laws  by  which  deformities  of  the  jaws 
and  irregularities  of  the  teeth  are  governed  had  been  worked 
out  on  broad  scientific  lines,  and  hence  made  due  allowance 
for  individual  peculiarities.  Rewriting  of  the  work  for  this 
edition  was  hence  deemed  unnecessary.  It  was  thought  best, 
however,  so  to  outline  in  an  introduction  the  working  of  the 
developmental  principles  governing  heredity  and  environment 
as  to  facilitate  their  application  to  the  topics  discussed  in  the 
different  divisions  of  the  subject. 


INTRODUCTION. 


More  than  thirty  years  ago,  an  extensive  dental  experience 
convinced  me  that  in  developmental  processes  the  face,  nose, 
jaws  and  teeth  were  more  involved  than  the  rest  of  the  body, 
and  were,  therefore,  under  the  laws  of  economy  of  growth, 
hence  most  involved  in  pathologic  change.  This,  as  now  gen- 
erally recognized,  is  underlain  by  developmental  states,  dis- 
torted into  excess  or  diminution.  Evolution  or  development 
proceeds  from  the  indefinite  simple  to  the  definite  complex 
with  a  resultant  saving  in  expenditure  of  force.  As  embryo- 
logic  development  in  man  proceeds  from  the  simple  cell 
to  a  union  of  cells  forming  structures,  organs,  and  finally 
the  body  which  these  unite  to  form,  two  processes  take  part 
in  it:  degeneration  of  cell  functions  to  secure  greater  special- 
ization in  the  organs  they  form,  and  degeneration  in  these 
organs  for  greater  accomplishment  by  the  body  of  certain 
functions  with  less  waste  or  force.  Evolution  of  the  body  as 
a  whole  is  aided  by  these  degeneracies.  When  degeneracy 
diminishes  lower  structures  for  the  advantage  of  the  higher, 
evolution  is  the  type  of  progress;  when  degeneracy  attacks 
the  higher  structures  for  the  benefit  of  the  lower,  as  in  para- 
sites, degeneracy  is  the  type  of  progress. 

Evolution  of  this  type  strikes  its  roots  deep  and  early  in 
Greek  philosophy,  where  Empedocles,  long  before  Aristotle, 
outlined  the  doctrine  of  evolution  and  survival  of  the  fittest. 
Aristotle  cleared  up  the  relation  of  structures  and  organs  to 
each  other,  and  the  sacrifice  of  one  to  another  for  the  benefit 
of  a  single  organ  or  the  body  as  a  whole.  This  principle, 
which  demonstrated  the  amount  of  nutriment  which  could  be 
assimilated,  was  limited,  and  that  active  organs  must  secure 
most  was  cleared  of  obscurity  first  by  Goethe  in  1807,  and  still 
more  by  Geoffroy  St.  Hilaire  in  1818.  Roux  later  applied  it 
to  physiology  and  pathology.  Upon  it  turn  all  biologic 
processes.     It  explains  all  so-called  freaks  of  nature,  which 


INTRODUCTION". 

are  simple  retroversions  of  evolution.  The  general  trend  of 
the  mixture  of  degeneracy  and  evolution  constituting  advance 
is  to  the  creation  of  checks  on  waste,  constituted  by  a  balance 
secured  by  a  more  and  more  complex  central  nervous  system. 
The  explosive  motor  expression  of  the  ganglionic  nerve  sys- 
tem is  lessened  as  the  central  nervous  system  gains  more 
ascendancy  in  passing  upward  from  the  sea-squirt  to  man. 
This  ascendancy  is  shown  in  the  reduction  of  nerve  force 
needed  in  sensation,  motion  or  in  nutritional  processes.  With 
rise  in  evolution  or  with  growth  in  human  embryogeny,  the 
brain  gains  at  the  expense  of  the  spinal  cord  and  at  the 
expense  of  the  structures  of  the  face.  More  brain  space  is 
needed,  and  the  dermal  bones  which  cover  this  space  gain  at 
the  expense  of  the  vertebral  structures  entering  into  the  skull 
and  face.  The  human  face,  with  all  its  beauty,  considered 
from  the  standpoint  of  food-getting,  chewing  and  combat,  is, 
as  Minot  has  shown,  assuming  an  embryonic  type.  The  jaws 
are  needed  less  and  less  for  the  purpose  mentioned,  hence, 
under  the  law  of  economy  of  growth,  the  resultant  disuse 
sacrifices  them  for  the  benefit  of  the  growing  brain  and  nerv- 
ous system  and  the  dermal  elements  of  the  skull.  Under  this 
operation  of  the  law  of  economy  of  growth  has  occurred  the 
aesthetic  evolution  of  the  face  from  the  anthropoid  to  the 
Apollo  Belvidere  type,  which  Camper  has  so  graphically  pic- 
tured. The  reverse  phase  of  evolution,  with  which  Camper 
did  not  deal,  is  that  of  which  the  present  work  treats.  This 
phase  of  evolution  underlies  all  pathology  of  the  face,  as  well 
as  of  the  nose,  jaws,  alveolar  process  and  teeth.  The  illus- 
trations supplementing  those  of  Camper  portray  this  reverse 
phase  where  symmetry  of  the  body  as  a  whole  is  sacrificed  to 
changes  in  the  nose,  jaws,  alveolar  processes  and  teeth,  so  as 
to  preserve  brain  gains. 

The  following  illustrations,  taken  from  photographs  of 
patients,  accurately  portray  arrests  of  the  face  for  the  benefit 
of  the  brain.  The  gradual  recession  of  the  face  and  the  for- 
ward development  of  the  brain  is  a  gradual  continuation  of 
Figure  36  in  the  line  of  evolution.  From  the  relations  of  this 
face  degeneration  nearly  all  diseases  of  the  nose,  jaws,  alveo- 


INTRODUCTION. 


lar  processes  and  teeth  result.     In  many  cases  reverse  evolu- 
tion   progresses    still    further   till,    owing   to   an   unbalanced 


6  '   7 

nervous  system  and  movements  of  the  lower  jaw,  atavism 
results.  Figure  8  and  Figure  9  exhibit  a  greater  exaggeration 
of  the  lower  jaw,  a  return  to  the  anthropoid  and  lower  negro 
type. 


PREFACE. 

The  earlier  editions  of  the  present  work  were  as  remarked 
in  1894  an  outgrowth  of  researches  which  tended  to  oppose  the 
too  prevalent  theory  (erroneous  in  its  deductions  and  vicious 
in  its  effects  on  practice)  that  irregularities  of  the  teeth  and  jaws 
were  the  result  of  local  not  constitutional  conditions.  In  the 
present  volume  in  accordance  with  the  general  trend  of  medical 
science,  biologic  data  have  largely  been  used  in  the  explanation 
of  pathologic  and  teratologic  results.  This  is  nothing  new  in 
dental  science  nor  in  general  medical  science  since  the  sciences 
separated  from  fetichism.  At  all  times,  lower  animals  have  been 
used  as  a  means  of  solving  pathologic  and  physiologic  problems. 
The  close  of  the  last  century  has,  however,  witnessed  an  attempt 
to  use  such  methods  philosophically.  The  known  structural  and 
functional  differences  between  the  animal  and  man  have  been 
employed  in  control  experiments.  In  the  use  of  embryology  in 
explanation  of  physiologic  and  teratologic  abnormality  the  pres- 
ent work  has  merely  followed  the  trend  of  clinical  investigation. 
An  attempt  has  been  made  to  control  errors  resultant  on  clinical 
observation  by  analysis  based  on  the  general  principles  of  physi- 
ology and  pathology.  While  the  present  work  contains  abun- 
dant clinical  evidence  in  favor  of  the  views  advanced,  this 
evidence  has  been  critically  analyzed  from  biologic,  embryologic, 
physiologic,  pathologic  and  sociologic  standpoints.  Many  of 
the  results  obtained  through  researches  elsewhere  recorded 
("Degeneracy:  Its  Causes,  Signs  and  Results,"  and  "Interstitial 
Gingivitis,  or  So-called  Pyorrhoea  Alveolaris")  are  used  in  the 
present  work  as  starting  points.  As  embryology,  biology  and 
teratology  (science  of  deformities)  are  extensively  used  in  cur- 
rent dental  literature  in  explanation  of  human  dental  processes, 
no  apology  need  be  made  for  their  employment  in  the  present 
volume.  The  present  work  is  practical  in  the  highest  sense  of 
the  term  which  means  avoidance  of  "rule  of  thumb"  theories 
based  on  exploded  obsolete  charlatanish  notions. 


Xll  PREFACE. 

The  abnormal  eruption  of  the  teeth  into  facial  cavities  other 
than  the  oral  has  rendered  a  discussion  of  these  cavities  abso- 
lutely necessary  for  the  purposes  of  the  dental  surgeon.  Unless 
the  development,  teratology  and  pathology  of  these  cavities  be 
understood  a  clear,  comprehensive  conception  of  the  relations 
of  irregularities  of  the  teeth  is  unattainable.  When  the  third 
edition  of  the  work  was  in  the  hands  of  the  profession  it  became 
apparent  to  the  author  from  the  opinions  of  reviewers  and  of 
dental  and  medical  journals,  as  well  as  from  letters  received,  that 
the  prevalent  conception  of  degeneracy  as  a  factor  of  growth  was 
obscure  and  misleading.  An  extended  and  comprehensive  exam- 
ination into  the  subject  seemed  imperative  and  the  result  of  this 
examination  was  the  production  of  the  work  upon  "Degeneracy : 
Its  Causes,  Signs  and  Results,"  published  by  the  firm  of  Walter 
Scott  of  London,  England.  This  work  has  met  with  enthusiastic 
commendation  not  only  from  biologists  but  likewise  from  con- 
servative physicians,  who,  like  the  venerable  Dr.  N.  S.  Davis  of 
Chicago,  are  of  a  belief  that  "it  has  opened  up  a  new  field  in 
medical  science." 

To  understand  and  appreciate  the  pathology  of  the  alveolar 
process  both  works  (Interstitial  Gingivitis,  or  So-called  Pyor- 
rhoea, Alveolaris  and  Irregularities  of  the  Teeth)  require  com- 
parative study. 

The  unwritten  law  in  general  medicine,  "that  to  know  the 
cause  is  half  the  treatment,"  is  also  applicable  in  the  treatment 
of  deformed  jaws  and  irregularities  of  the  teeth.  Believing  in  this 
law  the  author  has  devoted  his  time  outside  of  office  practice  to 
this  particular  department  of  the  specialty.  Without  the  knowl- 
edge of  etiology  no  one  can  successfully  correct  deformities  as  is 
evident  in  the  many  failures  by  men  who  profess  to  make  this  a 
specialty.  In  the  preparation  for  the  fourth  edition,  the  entire 
work  has  been  re-written  and  re-arranged  with  plenty  of  new 
material  and  new  facts,  the  result  of  twenty-six  years  of  constant 
research.  The  etiologic  views  advanced  in  the  third  edition  of 
this  work  were  not  generally  understood,  probably  because  of 
difficulty  of  harmonizing  the  various  disorders  of  the  body  with 
the  law  of  economy  of  growth. 

The  author  has  indelibly  stamped  his  individuality  in  the  first 


PREFACE.  XUl 

part  of  his  work,  but  still  more  is  this  the  case  in  the  second 
part.  He  has  confined  himself  entirely  to  his  own  appliances  and 
methods  of  treatment.  "Systems"  in  the  ordinary  charlatan-like 
sense  are  not  accepted  as  guides.  In  the  author's  opinion  the 
practitioner  should  be  familiar  with  the  etiology  of  the  case  in 
hand ;  his  knowledge  of  principles  and  mechanics  should  suggest 
to  him  the  most  suitable  appliances  for  the  given  case.  Every 
force  has  its  place  in  the  treatment  of  these  deformities.  The 
appliances  here  illustrated  have  all  been  successful  in  the  hands 
of  the  author  when  used  according  to  their  indications. 

For  preparation  of  specimens  discussed  in  Chapter  on  Pa- 
thologic and  Physiologic  Changes,  the  author  is  under  obliga- 
tions to  Drs.  L.  Hektoen,  M.  Herzog  and  F.  Noyes. 

For  illustrations  other  than  those  that  are  original,  the  author 
is  indebted  to  The  S.  S.  White  Dental  ^Manufacturing  Com- 
pany, The  Ophthalmic  Record,  Medicine  and  other  medical 
periodicals. 

103  State  Street.  EUGENE  S.  TALBOT. 


CONTENTS. 


CHAPTER.  PAGES. 

1.  History   1-17 

2.  Heredity    18-25 

3.  Congenital  Factors  and  Maternal  Impressions 26-29 

4.  Post-Natal  Skull  and  Jaw  Development  and  Periods 

of  Stress  30-39 

5.  Development  of  the  Cranium  and  Face 40-47 

6.  Development  of  the  Jaws 48-55 

7.  Development  of  the  Alveolar  Process 56-73 

8.  Development  of  the  Vault 74-86 

9.  Development  of  the  Peridental  Membrane 87-92 

10.  Development  of  the  Teeth 93-95 

11.  Social    Consanguinity    Near-kin,    Early   and   Late 

Marriage 96-101 

12.  Environment,  Climate,  Soil  and  Food 102-1 12 

13.  Race  Admixture   113-119 

14.  Constitutional  Disorders 120-126 

15.  Intellectual  and  ]\Ioral  Defects 127-147 

16.  Inter-Operations  of  Causes  and  Predispositions. .  .148-152 

17.  Developmental  Neuroses  of  the  Face 153-171 

18.  Developmental  Neuroses  of  the  Nose  and  Interior 

Facial  Bones   172-207 

19.  Developmental  Neuroses  of  the  Eye 208-213 

20.  Developmental  Neuroses  of  the  Bones  of  the  Ear.  . .        214 

21.  Developmental  Neuroses  of  Jaws  of  the  Seemingly 

Normal 215 

22.  Developmental  Neuroses  of  Maxillary  Bones 216-235 


XVI  CONTENTS. 

CHAPTER.  PAGES. 

23.  Developmental  Neuroses  of  the  Vault 236-289 

24.  Developmental  Neuroses  of  the  Palate 290-296 

25.  Developmental  Neuroses  in  Teeth  Position 297-322 

26.  Local  Causes  of  Teeth  Irregularities — Upper  Jaw.  .323-343 

27.  Local  Causes  of  Teeth  Irregularities — Lower  Jaw.  .344-357 

28.  Local  Causes    of    Teeth      Irregularities — Finger 

Sucking 358-361 

29.  The  Degenerate  Teeth 362-382 

30.  Surgical  Diagnosis 383-404 

31.  Pathologic  and  Physiologic  Changes 405-426 

32.  Surgical  Corrections 427-471 

APPENDIX. 
Tables 472-495 


ANTERO-POSTERIOR    AND     LATERAL     ILLUSTRA- 
TIONS OF  THE  VAULT. 

Illustrations 496-533 


Irregularities  of  the  Teeth. 


CHAPTER  I. 


HISTORY. 

Dentistry  was  a  very  early  specialty  of  medicine.  The  As- 
syrians, according  to  recent  investigations  by  Sayce  and  others, 
early  practiced  tooth  filling  with  gold  and  allied  procedures.  The 
folklore  belief  that  dental  decay  was  due  to  a  worm  in  the  tooth 
however  exerted  more  influence  then  than  it  does  now  among 
Aryan-speaking  peoples  other  than  in  the  Western  Highlands  of 
Scotland,  Ireland,  Poland,  Russia,  France,  Italy,  South  Germany 
and  Spain.  The  Assyrians  did  not  reach  a  level  in  medicine  and 
surgery  higher  than  that  of  the  Chinese  of  to-day,  who  are  pre- 
sumably the  inheritors  of  their  science.  In  Egypt  nearly  every 
branch  of  medicine  had  attained  a  relatively  high  status  at  the 
time  of  Herodotus.  Even  earlier,  as  shown  by  the  Ebers'  papy- 
rus, dentistry  was  a  differentiated  specialty  of  medicine.  Gold 
was  employed  by  the  Egyptians  not  merely  for  the  purpose  of 
filling  teeth  but  likewise  to  correct  irregularities.  Mummies  are 
found  containing  teeth  held  in  place  and  directed  by  gold  or 
silver  wires  or  plates.  In  Hindoo  civilization  dentistry  early 
reached  also  a  high  status  as  a  specialty  of  medicine,  albeit  such 
civilization  fell  later  into  decay  when  the  folklore  notion  of  dis- 
ease due  to  the  worm  in  the  tooth  resumed  its  prominence.  In 
the  time  of  Hippocrates,  caution  was  used  in  extracting  teeth  and 
preserving  them.  Hippocrates  attacked  principally  the  fetichic 
origin  of  disease.  As  this  played  a  large  part  in  compelling 
unnecessary  extraction  of  teeth  he  naturally  was  led  to  describe 
the  characters  of  teeth  and  the  indications  for  their  extraction. 
A  hundred  and  sixty  years  after  him  Erasistratus^  deposited  in 
the  temple  of  Apollo  at  Delphos  an  odontogogue  or  leaden  tooth 
forceps,  intimating  that  only  teeth  should  be  drawn  which  were 
loose  enough  to  be  extracted  with  this  instrument.  This  (an 
ex-voto  offering  for  recovery  from  disease)  was  probably  in- 
tended by  Erasistratus  as  a   popular  lesson  against  too  early 

^  Baas'  History  of  Medicine. 
2 


2  IRREGULARITIES    OF    THE    TEETH. 

extraction  of  teeth.  So  far  as  dentistry  is  concerned  the  Romans 
were  as  much  influenced  by  Etruscan  as  by  Greek  culture,  al- 
though this  last  had  a  very  early  influence.  The  Etruscans  prac- 
ticed dental  procedures  resembling  but  more  complete  even  than 
those  of  Greece.  In  Rome  artificial  teeth  and  dentures  evidently 
modeled  on  Etruscan  types  were  made  ere  the  period  of  the  laws 
of  the  "Twelve  Tables."  Celsus  (A.  D.  30)  practiced  dentistry 
rather  in  rough  surgical  manner  than  by  these  conservative  meth- 
ods. Galen  (150  A.  D.)  gave  the  canine  teeth  the  present  popular 
term  "eyeteeth,"  because  he  believed  they  were  supplied  by  the 
optic  nerve.  Greek,  Etruscan,  Roman  and  Arabian  culture  met 
at  the  famous  school  of  Salernum,  which  sprang  up  about  700 
A.  D.  Under  its  influence  dentistry  was  more  practiced  by  sur- 
geons and  physicians,  whereas  it  had  been  previously  largely 
confined  to  charlatans.  Bruno  of  Lango-buro,  about  the  middle 
of  the  thirteenth  century,  described  various  operations  upon  the 
teeth  and  antrum  nearly  four  centuries  before  Highmore.  In 
the  fifteenth  century  Giovanni  d'Arcoli  filled  teeth  with  gold 
and  made  attempts  at  corrections  of  irregularities.  In  1618  the 
famous  anatomy  of  Helkiah  Crooke  was  published.  From  this 
Shakespeare  drew  many  illustrations.  It  not  only  discussed  the 
brain  and  its  membranes,  but  even  variations  in  the  numbers  of 
molars.  Before  this  in  France,  Dionis  and  Verduc  had  made 
contributions  along  the  line  of  the  correction  of  irregularities. 
The  first  great  French  work  on  dentistry  issued  in  1728  by  Fau- 
chard  was  "Le  Chirurgien  Dentiste."  Auzebi  of  Lyons  soon 
after  wrote  a  similar  work.  In  Germany  the  influence  of  the 
French,  Italian  and  English  schools  is  demonstrated  in  the  rec- 
ognition of  the  dental  specialty  in  Universities  by  creation  of 
special  chairs. 

Irregularities  of  the  teeth  were  therefore  very  early  recog- 
nized, and,  equahy  early,  attempts  were  made  at  their  correction. 
To  the  considerable  extent  of  this  recognition,  in  prehistoric 
times,  comparatively  speaking  the  work  of  the  Etruscans  bears 
witness.  The  same  influences  which  have  ever  aided  radical 
surgery  at  the  expense  of  conservative,  were  predominant  in 
dentistry.  It  was  easier  to  remove  teeth  with  the  charlatan  than 
to  preserve  them  with  the  dental  scientist. 


HISTORY.  6 

Crooke,  discussing  second  dentition,  remarks  that :  "the 
shearing  (i.  e.,  incisors)  teeth,  when  they  do  break  forth,  do 
thrust  the  first  shearers  out  before  them  and  issue  betwixt  the 
first  two,  the  second  and  the  dog  tooth  that  is  next  unto  them. 
But  if  the  former  teeth  will  not  fall  or  be  not  pulled  out,  or  if  the 
latter  issue  before  the  first  fall,  then  the  latter  make  their  way 
through  new  sockets,  and  turn  in  the  upper  jaw  outward,  in  the 
lower  jaw  inward,  so  that  there  seemed  to  arise  a  new  row  of 
teeth  and  this  hath  deceived  many  historians  and  anatomists 
also." 

The  views  of  Crooke  seem  to  have  impressed  later  students  of 
"dentistry  more  than  was  first  apparent.  During  the  next  two 
centuries  are  found  references  to  conditions  produced  by  super- 
numerary teeth  on  the  one  hand  and  narrow  jaws  on  the  other. 
Barth  Ruspini  a  century  and  a  quarter  after  Crooke  claims  that 
all  teeth  which  exceeded  thirty-two  may  be  regarded  as  super- 
numerary. In  his  opinion  irregularities  of  the  canines  and 
incisors  were  attributable  to  extreme  narrowness  of  the  jaws. 

Half  a  century  later  Robert  Blake-  describes  supernumerary 
ind  inverted  teeth.  A  little  over  three  decades  later  than  Blake, 
Joseph  Harris^  and  Joseph  Winckworth  remarked  that  irregu- 
'arities  were  due  to  supernumerary  teeth. 

As  the  views  of  irregularities  broadened,  studies  of  their  cau- 
sation became  imperative.  For  the  same  reason  that  local  causes 
assume  undue  prominence  in  medicine,  they  suggested  them- 
selves to  dentists,  studying  irregularities  of  the  teeth.  Among 
these  causes  (still  in  considerable  favor  among  dentists,  laryngol- 
ogists  and  general  practitioners)  may  be  mentioned  thumb-suck- 
ing, mouth-breathing  and  enlarged  tonsils.  Although  thumb- 
sucking  is  claimed  as  a  late  nineteenth  century  explanation  of 
irregularities  of  the  jaws  and  teeth,  it  was  given  as  a  possible 
explanation  by  J.  Imrie-*  nearly  six  and  one-half  decades  ago. 
He  remarks  that  "Irregularity  is  due  to  want  of  development  of 
jawbones,  intemperance  of  various  kinds  combined  with  arti- 
ficial modes  of  living  introduced  by  civilizaton  and  sudden  tran- 

-  Inaugural  Dissertation,  1798. 

3  A  Familiar  Treatise  on  the  Teeth,  1830. 

*  Parent's  Dental  Guide,  1834. 


4  IRREGULARITIES    OF    THE    TEETH. 

sition  from  heat  to  cold  to  which  the  teeth  are  subject.  All  these 
have  a  tendency  to  prevent  development  of  the  bones.  Rabbit 
mouth  is  due  to  keeping  the  thumb  in  the  mouth  for  hours  after 
going  to  sleep.  Underhung  jaw  is  due  to  sucking  the  tongue  by 
throwing  the  under  jawbone  from  its  articulation.  A  similar 
state  of  the  teeth  and  jawbone  is  induced  when  attempts  are 
made  by  the  inexperienced  to  regulate  them  by  the  extraction 
of  teeth  in  the  upper  jaw  and  neglecting  to  remove  an  equal 
number  of  the  lower." 

J.  Lefoulon^  is  of  opinion  that  the  most  frequent  cause  of 
dental  irregularity  is  the  neglect  of  proper  supervision  of  the 
second  dentition.  \"ery  often  the  temporary  teeth  are  too  precip- 
itately removed  and  again  the  opposite  error  is  committed  by 
suffering  them  to  remain  after  the  permanent  have  partly 
appeared.  From  this  results  an  error  of  relation  between  the 
development  of  the  palatine  arch  and  the  superior  alveolar  bor- 
der, or  of  the  two  arches  at  once  relatively  to  the  size  of  the  teeth. 
Another  cause  is  the  bad  habit  of  permitting  children  to  suck 
their  thumbs  and  continually  to  be  putting  their  thumbs  into 
their  mouths.  Another  cause  is  the  frequently  repeated  action 
of  the  tongue  in  the  pronunciation  of  certain  syllables  called  lin- 
gual, in  which  that  organ  striking  against  the  anterior  superior 
teeth  gives  rise  to  anterior  obliquity  of  the  superior  arch.  This 
deformity  very  frequently  results  among  the  English-speaking 
from  pronunciation  of  lingual  syllables. 

The  same  year  Thomas  Ballard  charged  that  serrated  teeth 
and  projecting  jaws  were  the  result  of  fruitless  sucking. 

According  to  Stockton^  "The  comparative  ease  by  which, 
with  pressure,  the  incisors  or  bicuspids  may  be  made  to  alter 
their  position  would  naturally  suggest  the  idea  that  the  tongue, 
lips,  or  cheek  might  in  some  measure  influence  their  original 
direction.  But  as  these  are  pressed  by  everyone,  while  certain 
individuals  only  have  their  teeth  moved  unevenly  arranged,  we 
must  look  for  some  other  accessory,  and  this  may  be  found  in 
the  form  of  the  palate,  certain  peculiarities  of  which  are  found  in 
connection  with  similar  forms  of  the  dental  arch.    Irregularity  of 

^  Theory  and  Practice  of  Dental   Surgery,   Bond's  Translation,   1844. 
'  Dental  Intelligencer,  1845. 


HISTORY.  5 

position  is  almost  cxchisively  confined  to  the  five  anterior  teeth 
on  each  side  of  the  niecHal  Hne,  ])roui;ht  al)ont  by  tlie  pressure  of 
the  tongue  upon  the  hard  palate  in  sucking  or  mastication." 

According  to  Nasniyth'  the  projecting  upper  jaw  often  results 
from  the  habit  of  sucking  the  thumb  or  finger  in  infancy.  But 
both  projecting  upper  and  projecting  lower  jaw  arise  from 
arrest  of  development  in  the  jaw  when  the  expansion  of  the  arch 
is  deficient.  The  prominent  mouth,  in  his  opinion,  is  most  fre- 
quent in  civilized  races. 

The  influence  of  thumb-sucking  was  still  more  emphasized 
eight  years  later  by  H.  H.  Ross,  who  at  the  same  time  remarked 
that  as  soon  as  there  was  an  attempt  at  correction,  there  was 
greater  difficulty  in  keeping  the  teeth  in  position  after  they  were 
moved  than  in  moving  them.  During  the  next  twenty  years 
opinions  as  to  the  influence  of  thumb-sucking  continued  to  grow 
in  number.  In  1873  '^-  ^^-  ^^^  Lessert  attributed  great  influence 
to  thumb-sucking  and  to  enlarged  tonsils.  Thomas  Salter^ 
attributed  irregularities  to  thumb-sucking  and  tongue  hyper- 
trophy. J.  W.  White  was  of  opinion  that  protrusion  of  the  lower 
jaw  was  due  to  the  habit  of  sucking  the  first  and  second  fingers. 
The  weight  of  the  hand  and  arm  exerted  an  influence  in  causing 
a  protrusion  of  the  lower  jaw  and  teeth. 

In  Francis  Fox's^  opinion  the  causes  of  irregularity  were 
"The  want  of  proportion  in  the  size  of  the  teeth  and  the  jaw- 
bones or  prolonged  retention  of  temporary  teeth,  supernumerary 
teeth,  the  habit  of  thumb-sucking,  undue  pressure  from  an  hyper- 
trophied  tongue  or  heredity. 

In  Helkiah  Crooke's  summary  of  the  opinions  of  his  day 
the  influence  of  the  temporary  teeth  in  producing  irregularities 
had  been  pointed  out.  These  views  influenced  not  a  few  suc- 
ceeding investigators.  About  a  century  and  a  half  after  the 
appearance  of  Crooke's  work  Thomas  Berdmore  claimed  that 
the  presence  of  supernumerary  teeth  or  of  a  double  row  of  teeth 
is  due  to  the  fact  that  the  milk  teeth  are  never  shed  notwithstand- 
ing the  fact  that  the  permanent  teeth  appear.    Irregularity  of  the 

"  Development,   Structure   and  Diseases   of   the  Teeth,   1845. 

^  Dental  Surgery,   1874. 

^  Irregularities  of  Teeth  and  Their  Surgical  Treatment,  1880. 


6  IRREGULARITIES    OF    THE    TEETH. 

teeth  is  due  to  the  resistance  offered  by  the  permanent  by  the 
temporary,  which  also  occasioned  snaggled,  rough  and  indented 
teeth. 

According  to  Joseph  Fox^^  the  most  frequent  cause  of  irreg- 
ularity is  a  want  of  simultaneous  action  between  the  increase  of 
the  permanent  teeth  and  the  decrease  of  the  temporary  ones  by 
the  absorption  of  their  fangs,  most  commonly  occasioned  by  the 
resistance  of  the  nearest  temporary  teeth.  It  also  results  from 
the  fact  that  the  permanent  teeth  are  too  large  for  the  space 
occupied  by  the  temporary.  The  growth  of  more  teeth  than 
the  natural  number  frequently  occurs  and  is  always  the  cause  of 
greater  irregularity  of  the  teeth. 

Joseph  Murphy'^^  regards  irregularity  as  due  chiefly  to  the 
first  teeth  not  having  been  shed  in  time. 

In  the  opinion  of  Benjamin  James^-  proper  attention  to  the 
removal  of  the  first  teeth  avoided  irregularity  of  the  second  set. 

Parmly^^  is  of  opinion  that  want  of  attention  during  the 
period  of  shedding  the  first  set  of  teeth  is  the  great  cause  why 
irregularity  of  the  teeth,  and  consequent  deformity  of  the  mouth, 
are  apt  to  take  place.  When  the  permanent  are  large  and  growth 
of  the  jaw  does  not  proceed  in  a  corresponding  proportion  they 
are  found  to  crowd  and  overlap  each  other.  G.  Waite^*  found 
that  irregularities  of  the  teeth  are  mostly  occasioned  by  the  pres- 
sure of  the  temporary  upon  the  permanent,  throwing  them  in 
the  wrong  direction. 

According  to  S.  S.  Fitch^'"'  irregularity  is  due  to  want  of 
simultaneous  action  between  the  increase  of  the  permanent  teeth 
and  the  decrease  of  the  temporary  by  the  absorption  of  their 
fangs,  as  well  as  to  greater  size  of  the  permanent  teeth  in  com- 
parison with  the  temporary.  This  is  an  adoption  of  the  views 
and  even  of  the  language  of  Joseph  Fox. 

J.  B.  Garriot^*'  is  of  the  opinion  that  deciduous  teeth  by  their 

1"  Natural  History  of  Human  Teeth,  1803. 

11  Natural  History  of  Human  Teeth. 

12  Management  of  the  Teeth,  1814. 

13  Natural  History  and  Management  of  the  Teeth.  1820. 

"  Surgeon-Dentist's   Anatomic   and    Physiologic   Manual,    1S26. 

i"^  System  of  Dental  Surgery,  1835. 

18  Treatise  on  Diseases  of  the  Mouth,  1843,  Savier's  Translation. 


HISTORY.  7 

presence  often  prevent  the  permanent  teeth  from  arranging 
themselves  in  their  proper  position.  Neglect  to  extract  the  milk 
teeth  and  of  other  measures  favoring  good  arrangement  of  the 
permanent  teeth,  deformity  (often  very  serious)  may  result. 

One  possible  factor  of  dental  irregularities  which  had  been 
very  early  considered  was  peculiar  growth  of  the  jaw.  This 
was  discussed,  as  has  been  already  remarked,  by  Barth  Ruspini 
in  1750.  The  great  biologist,  John  Hunter,  who  paid  some  atten- 
tion to  this  factor,  states'^ '^  that  the  jaw  grows  at  the  posterior 
edges  and  that  an  irregularity  is  often  due  to  the  ten  anterior 
permanent  teeth  being  larger  than  the  ten  anterior  temporary 
teeth,  while  the  corresponding  part  of  the  jaw  is  of  the  same  size. 
Therefore,  in  such  cases  the  second  set  is  obliged  to  stand  very 
irregularly. 

From  observations  made  on  young  pigs,  G.  M.  Humphrey 
claims  that  there  is  no  interstitial  growth.  The  five  permanent 
teeth  occupy  exactly  the  same  position  throughout  life  and  all 
other  conditional  teeth  are  added  to  the  hinder  end  of  the  jaw. 
This  hind  end  is  enlarged  by  the  absorption  of  the  anterior 
coronoid  edge  and  the  deposition  on  the  posterior  edge.  When 
the  molars  are  first  formed  they  are  under  the  coronoid  process 
and  are  frequently  exposed. 

Another  factor  which  received  considerable  attention  both  as 
a  predisposing  and  exciting  cause  is  premature  extraction  of 
temporary  teeth. 

According  to  the  work  of  L.  Koecker.  published  in  1826,  the 
deformity  which  consists  in  shutting  the  under  incisors  and  cus- 
pidati  over  the  upper  has  been  produced  by  the  injudicious  ex- 
traction of  some  of  the  teeth  of  the  upper  jaw  without  taking 
proper  care  to  secure  due  proportion  between  the  upper  and 
under  jaws.  Irregularity  also  occurs  when  the  temporary  teeth 
are  not  extracted  in  time  and  when  too  long  persistence  of  these 
occurs. 

According  to  Thomas  BelP'^  the  most  unusual  cause  of  per- 
manent irregularity  is  the  actual  want  of  sufficient  room  in  the 
jaw  for  the  ultimate  regular  arrangement  of  the  teeth.    This  may 

1^  Natural  History  of  the  Teeth,  1771. 

18  Anatomy,  Physiology,  and  Diseases  of  the  Teeth,  1829. 


8  IRREGULARITIES    OF    THE    TEETH. 

occur  from  disproportionate  narrowness  of  the  jaw  (whether 
from  original  formation  or  produced  by  too  early  removal  of 
temporary  teeth)  or  from  prenatural  size  of  the  permanent  teeth. 

In  Joseph  Scott's^"  opinion,  irregularities  arise  from,  first,  a 
natural  want  of  sufificient  expansion  in  the  jawbone  at  the  time 
of  their  protrusion ;  second,  from  not  extracting  the  temporary 
teeth  at  the  proper  time ;  third,  from  too  early  extraction  of  the 
temporary  teeth  ;  foiu-th,  from  supernumerary  teeth. 

John  Nicholles"^  found  that  deformity  may  be  due  to  too  long 
persistence  of  the  temporary  teeth,  or  may  arise  from  some  mal- 
formation of  the  teeth  or  jaw  entirely  beyond  the  previous  con- 
trol of  the  dentist. 

According  to  M.  Maclean,^!  due  expansion  of  the  jaw  is  pre- 
vented by  premature  extraction  of  the  temporary  teeth.  The  tem- 
porary teeth  being  not  extracted,  the  permanent  teeth  are  thereby 
crowded  and  irregular. 

E.  Spooner--  has  found  that  the  first  and  most  frequent 
cause  of  irregularity  is  a  want  of  simultaneous  action  between 
the  protrusion  of  the  permanent  teeth  and  absorption  of  the 
fangs  of  the  temporary.  The  second  cause  is  a  narrowness  of 
the  maxillary  arch  or  a  want  of  proportion  between  the  extent 
of  it  and  the  size  of  the  teeth.  Another  cause  is  premature 
extraction  of  the  temporary  teeth.  The  jaw  is  liable  to  con- 
traction and  when  the  permanent  come  in  there  is  not  room  in 
the  jaw  for  them,  irregularity  is  due  also  to  supernumerary  teeth. 
According  to  William  Thornton-^  irregularities  of  the  teeth 
proceed  from  three  causes.  First,  from  a  natural  want  of  suffi- 
cient expansion  in  the  jawbones  at  the  time  of  the  protrusion 
of  the  teeth ;  second,  not  extracting  the  temporary  teeth  at  their 
proper  time  ;  third,  too  early  an  extraction  of  the  temporary  teeth. 

Mortimer  about  the  same  time  expressed  the  opinion  that 
irregularities  of  the  teeth  arise  from  natural  or  accidental  causes. 
Natural  causes  arise  from  the  bad  conformation  of  the  jaw  so 

1^  Art  of  Preventing  Loss  of  Teeth,  1831. 

20  Teeth  in  Relation  to  Beauty,  Voice,  and  Health,  1833. 

21  Treatise  on  Human  Teeth,  1836. 

22  Popular  Treatise  on  the  Teeth,  1836. 

•^  Treatise  on   the  Preservation  of  the  Teeth  and  Gums,   1836. 


HISTORY.  9 

that  several  tcctli  arc  over  each  other.  h>om  the  teeth  being 
much  larger  than  they  should  he.  fn^ni  coming  out  of  order  and 
place,  from  teeth  growing  out  of  the  palate  or  projecting  out  of 
the  luoiUli.  Accidental  causes  arise  from  neglect  or  ignorance 
in  removing  milk  teeth  too  soon  ;  when  the  second  teeth  take  a 
direction  inward  or  outward  from  some  internal  cause;  under- 
hung jaws  arise  from  making  faces. 

According  to  Charles  de  Loude-^  irregularity  is  due  to  super- 
numerary teeth,  to  second  teeth  being  too  large  and  maxillary 
arch  too  narrow,  and  too  early  extraction'  and  too  long  persis- 
tence of  temporary  teeth,  and  to  shape  of  the  maxillary  arch,  and 
to  heredity,  where  the  child  inherits  the  jaw  of  one  parent  and  the 
teeth  of  another. 

About  three  years  later  Sam  Ghimcs  spoke  of  the  underhung 
jaw  being  due  to  the  upper  incisors  extending  inwards  and  in 
closing  the  mouth  they  come  in  contact  with  the  lower.  This 
makes  the  child  inclined  to  protrude  the  lower  jaw,  which  finally 
becomes  habitual  and  promotes  the  increase  in  the  length  of  the 
jaw  itself. 

Nessel--"  attributes  irregularity  to  the  premature  extraction  of 
temporary  teeth.  The  alveoli  form  a  bone  scar  in  such  cases 
which  constitutes  an  obstacle  to  the  advancement  of  the  perma- 
nent teeth.  In  consequence  the  permanent  teeth  come  before 
the  jaw  is  sufficiently  expanded  to  receive  them.  Between  i860 
and  1880  niQUth  breathing,  especially  during  sleep,  formed  a 
prominently  discussed  etiologic  factor. 

Tomes-"  expressed  the  opinion  that  deformity  of  the  jaw  is 
often  caused  by  sleeping  with  the  mouth  open.  This  factor 
Tomes  had  not  mentioned  in  the  1848  edition  of  his  work.  Cat- 
lin,  the  ethnologist,  made  a  great  popular  propaganda  in  favor 
of  nose  breathing.  He  ascribed  many  diseases  to  keeping  the 
mouth  open.  Malformations  of  the  jaws  and  teeth  were  due  to 
keeping  the  mouth  open,  since  civilized  man  is  the  only  animal 
who  keeps  his  mouth  open  during  sleep.    This  view  still  meets 

-■*  Surgical.  Operative  and  Mechanical   Dentistry,   1840. 
-■'"'  Compendium   der   Zahnheikunde,    1856. 
-•^  Dental  Surgery,  1859. 


10  IRREGULARITIES    OF    THE    TEETH. 

with  much  favor  among  dentists  and  laryngologists.  It  is,  how- 
ever, losing  caste  with  the  paediatricians. 

W.  Matthews-'^  sixteen  years  later  than  Catlin  advanced 
similar  views.  Irregularities  were  attributable  to  enlarged  tonsils 
which  necessitate  breathing  being  carried  on  with  open  mouth. 
They  were  also  due  to  heredity.  The  maxilla  was  smaller  in  pro- 
portion than  the  teeth,  owing  to  the  lessened  work  of  the  jaws 
and  teeth  among  civilized  races.  Cross  breeding  played  an  im- 
portant part,  as  did  thumb-sucking  and  lip-sucking;  retarded 
shedding  of  the  temporary  teeth  and  too  early  extraction  of  the 
first  permanent  molars.  The  congenital  V-shaped  jaw  is  that 
formed  where,  previous  to  birth,  the  type  of  upper  maxillae  is  such 
that  its  cornua  do  not  diverge  posteriorly  but  are  parallel.  As 
that  portion  of  the  jaw  already  formed  never  changes  its  form, 
the  newly  added  parts  will  pass  off  in  divergent  lines,  forming  an 
angle  with  previously  existing  in  order  to  correspond  with  the 
increasing  width  of  the  base  of  the  skull.  The  growing  tendency, 
exhibited  from  the  time  of  Crooke,  to  assign  constitutional  fac- 
tors important  places  in  the  etiology  of  the  teeth  and  jaw  irreg- 
ularities, is  especially  observable  in  the  work  of  Matthews.  He, 
while  laying  stress  on  local  factors,  was  forced  to  recognize  the 
importance  of  constitutional  factors.  Constitutional  factors, 
hence,  early  began  to  assume  considerable  importance.  John 
Fuller,  while  attributing,  in  1810,  irregularity  to  long  persistence 
of  temporary  teeth,  also  remarked  that  the  upper  jaw  is  often  too 
small  for  the  permanent  teeth,  this  condition  frequently  resulting 
in  its  irregularity.  In  Sigmond's-^  opinion,  irregularity  is  due  to 
natural  and  accidental  causes.  Causes  are  natural :  (i)  when  they 
result  from  the  jaw  not  expanding  sufficiently  to  allow  the  teeth 
to  form  a  regular  circle ;  (2)  when  they  are  larger  than  the  ordi- 
nary dimensions ;  (3)  when  they  do  not  appear  in  their  proper 
order  and  place.  Causes  are  accidental  when  due  to  negligence 
or  improper  treatment  at  the  time  of  growth. 

According  to  Andrew  Clarke,^^  that  irregularity  of  the  teeth 
is  occasioned  by  want  of  room  in  the  jaw,  and  not  from  any 

-~  London  Dental  Hospital  Transactions,  1880. 

-*  Treatise  on  Disease  and  Irregularities  of  the  Teeth  and  Gums,  1825. 

-''  Practical  Directions  for   Preserving  the  Teeth,  1825. 


HISTORY.  11 

effect  that  the  first  set  of  teeth  may  produce  upon  them,  is  evi- 
dent from  the  fact  in  all  cases  of  irregularity  there  is  not  room  to 
admit  of  placing  the  teeth  properly. 

According  to  J.  P.  Clark-"^"  irregularity  may  arise  from  too 
premature  extraction  of  temporary  teeth.  Disproportion  be- 
tween the  teeth  and  jaws  may  be  occasioned  by  a  natural  con- 
formation of  the  parts  or  may  be  the  effect  of  unnoticed  accident. 
For  we  seldom  found  any  such  disproportion  and  consequent 
irregularity  in  the  teeth  of  men  and  animals  in  a  wild  state. 

According  to  William  Robertson^^  deformity  is  due  to  in- 
heritance of  the  contracted  jaw  of  one  parent  and  the  large  teeth 
of  the  other. 

According  to  David  W.  Jobson^-  an  irregularity  is  due  to 
smallness  of  maxillary  arch  and  the  great  size  of  the  permanent 
teeth  and  their  situation,  part  on  inner  and  of  others  on  outer 
side  of  permanent  teeth. 

John  Mallan^''^  remarks  that  the  adult  teeth  being  larger  as 
well  as  more  numerous  than  the  milk  teeth,  it  is  obvious  that 
they  require  a  great  deal  more  room,  and  when  the  absorption 
of  the  latter  does  not  progress  equally  with  the  growth  of  the 
former,  the  new  teeth  are  crowded  up  and  aie  apt  to  be  forced 
out  of  their  natural  position  by  the  resistance  of  the  old.  Again, 
if  the  permanent  prove,  as  they  sometimes  do,  disproportionately 
large  in  comparison  with  their  predecessors,  the  jaw  may  not  be 
sufficiently  extended  to  admit  of  their  being  arranged  in  order, 
in  which  case  some  overlap  the  others  and  considerable  deform- 
ity is  occasioned. 

According  to  Maury^-*  prominence  of  the  upper  jaw  is  due  to 
narrowness  of  the  arch;  recession  to  the  anterior  teeth.  Paul 
Goddard^^  expresses  the  opinion  that  the  most  prolific  cause  of 
irregularity  is  want  of  room  in  the  dental  arches.  This  arises 
sometimes   from   congenital   effects   but   more   commonly  from 

30  A  New  Sj'stem  of  Treating  Human  Teeth,  1829. 
21  Practical  Treatise  on  the  Human  Teeth,  1841. 

32  On  the  Teeth,  1834. 

33  Practical  Observations  on  Phj'siology  and  Diseases  of  the  Teeth, 
1835- 

3^  Dental  Art,  1842,  Savier's  Translation. 

35  Anatomy,   Pathology  and  Physiology  of  the  Teeth,  1844. 


12  IRREGULARITIES    OF    THE    TEETH. 

early  decay  and  loss  of  the  temporary  teeth  which,  failing  to 
keep  up  the  alveoli,  enable  the  jaw  to  contract  and  thus  afford 
too  little  room  for  the  permanent  set. 

According  to  C.  A.  Harris^*'  an  infringement  of  the  laws  of 
growth  or  disturbance  of  the  organs  of  the  face  or  head  may 
determine  improper  development  of  the  jaws  and  bad  arrange- 
ment of  the  teeth.  Irregularity  of  the  teeth  is  due  to  narrowness 
of  the  maxillary  arch  and  sometimes  to  the  presence  of  the 
temporary  teeth. 

Arthur^'''  states  irregularities  of  the  teeth  may  proceed  among 
other  things  from  three  principal  causes :  First,  the  presence  of 
the  greater  number  of  teeth  in  the  mouth  than  is  natural.  Sec- 
ond, a  deficiency  of  space  in  the  jaw.  Third,  a  wrong  direction 
given  to  one  or  more  at  the  time  they  make  their  appearance.  A 
deficiency  of  space  may  arise  from  a  contraction  of  the  jaws  in 
consequence  of  the  too  early  extraction  of  the  temporary  teeth ; 
or  from  some  original  malformation  of  the  jaw,  or  from  a  great 
excess  in  size  of  the  second  set  over  the  first. 

According  to  W.  K.  Brideman^s  the  tongue,  lips  and  cheek 
exert  no  influence  in  moving  the  teeth  from  their  original  direc- 
tion.   This  is  due  to  the  shape  of  the  jaw. 

According  to  Sam  Harbert^^  irregularities  of  the  teeth  are 
due  to  premature  extraction  of  the  deciduous  teeth  and  protru- 
sion of  the  permanent  before  the  absorption  of  a  deciduous  fang. 
A  projection  of  the  lower  jaw  is  attributable  to  neglect  in  second 
dentition.  Generally  it  is  supposed  to  be  due  to  elongation  of 
the  jaw  which  is  almost  always  an  error.  When  the  dental  arch 
becomes  contracted  at  the  medial  line,  giving  to  the  mouth  a 
pointed  appearance,  it  is  often  the  result  of  premature  extraction 
of  temporary  teeth. 

According  to  Alfred  Canton*^  irregularity  of  teeth,  as  regards 
shape,  position,  direction,  crowded  condition,  etc..  is  met  with 
more  frequently  than  is  supposed  to  be  the  case.     The  causes 

^^  Principles  and  Practice  of  Dental  Surgery,  1845. 
^''  A  Popular  Treatise  on  Diseases  of  the  Teeth,  1845. 
3^  Causes  of  Irregularities  of  the  Teeth,  1845. 

^^  Practical  Treatise  on  the  Operations  of  Surgical  and  Mechanical 
Dentistry,  1847. 

*"  Teeth  and  Their  Preservation,  1851. 


HISTORY.  13 

are  chiefly  mechanical,  depending  either  on  the  non-increase  in 
size  of  the  jaw  in  proportion  to  the  growth  of  the  teeth  to  be 
contained  in  the  alveohir  arch ;  on  the  position  of  the  permanent 
teeth  with  reference  to  the  fangs  of  their  predecessor,  and  lastly, 
on  the  increase  in  size  of  one  jaw  in  preference  to  the  other. 

C.  F.  Delabarre^^  is  of  opinion  that  malformation  of  denture 
may  be  occasioned  by  defective  conformation  of  the  jaw,  by 
simple  arrest  of  development  dependent  upon  the  health  of  the 
individual  by  excess  in  development  of  the  teeth  though  the  jaws 
be  in  other  respects  well  formed,  by  rapid  development  in  the 
dentition  of  one  set  and  delay  in  that  of  the  other  by  the  too  great 
size  of  the  teeth  of  one  jaw  which  do  not  harmonize  with  those 
that  are  opposite.  Some  forms  of  defective  palatine  arches  are 
hereditary. 

According  to  J.  R.  Du\'al^-  in  a  projecting  chin,  the  alveolar 
arch  in  which  the  incisors  and  canines  are  placed,  has  taken  a 
development  upon  a  parabolic  line — greater  and  more  prominent 
than  that  presented  by  the  bone.  This  differs  very  little  from  a 
similar  one  in  the  upper  jaw  which  projects  over  the  lower.  Upon 
attention  to  shedding  of  the  temporary  teeth  depends  the  fine 
arrangement  of  the  lower. 

GunnelH^  finds  that  protrusion  of  the  lower  jaw,  while  in 
many  cases  hereditary,  is  often  brought  about  in  the  following 
manner.  The  incisors  of  the  lower  jaw  are  cut  first,  and  when  the 
upper  ones  appear,  the  lower  have  nearly  arrived  at  full  growth. 
In  closing  the  mouth,  they  come  in  contact  with  the  gum  on  the 
inside  of  the  upper  incisors  and  for  relief  the  lower  jaw  is 
thrust  out,  which  condition  soon  becomes  permanent. 

According  to  Samuel  Cartwright,  Jr.,-^^  irregularities  of  the 
permanent  are  due  first  to  non-absorption  of  the  roots  of  the 
temporary  teeth  in  proportion  to  the  rise  of  those  of  replacement. 
Second,  to  the  great  difiference  which  commonly  exists  in  the  size 
of  the  new  teeth  as  compared  with  those  of  the  first  set.  Third, 
to  contraction  of  the  arches  of  the  jaws  and  other  malformations 

*^  Treatise  on  Second  Dentition. 

^2  The  Youth's  Dentist. 

*3  Americal  Journal  of  Dental  Science,  1853. 

**  British  Journal  of  Dental  Science,  1857. 


14  IRREGULARITIES    OF    THE    TEETH. 

of  the  maxillary  and  palate  bones  originating  in  hereditary,  con- 
genital and  other  causes. 

In  i860  extensive  observations  were  made  by  Messrs.  Mum- 
mery and  Nichols  upon  the  teeth  of  primitive  races.^^  They 
found  that  irregularities  of  the  teeth  and  contracted  jaws  were 
rare.  Observations  of  Messrs.  Coleman  and  Cartwright  on  prim- 
itive skulls  found  in  Kent,  England,  showed  that  these  had  well 
developed  jaws  and  alveolar  arches.  The  teeth  still  present  were 
remarkably  regular. 

In  a  paper  read  before  the  British  Odontologic  Society  Sam- 
uel Cartwright  expressed  an  opinion  in  1864  that  irregularities 
result  from  selective  breeding;  that  they  are  both  congenital 
and  hereditary ;  that  there  is  very  little  increase  in  the  anterior 
part  of  the  jaw  after  eight  or  ten  years.  That  if  the  temporary 
teeth  were  to  remain  the  jaws  would  not  change  from  those  of 
childhood.  That  in  all  cases  of  irregularity  the  maxillae  are  more 
or  less  altered  in  proportion  of  development  whilst  the  teeth 
maintain  in  regard  to  size  an  average  development. 

According  to  A.  A.  Blount,'*^  remote  causes  which  produce 
irregularity  will  be  found  in  the  commingling  of  all  nations  with 
national  and  individual  characteristics.  The  most  frequent  causes 
are  the  result  of  accident,  indiscriminate  action  of  the  deciduous 
teeth  and  too  early  extraction  of  the  permanent  teeth. 

According  to  H.  SewelH'''  protrusion  of  the  incisors  is  appar- 
ently due  to  an  abnormal  development  of  the  maxillary  bone. 
Irregularities  are  due  to  retention  of  temporary  teeth  causing 
permanent  teeth  to  assume  an  unnatural  position ;  also  to  mal- 
formation of  the  jaw,  which  is  usually  congenital  and  at  the  same 
time  hereditary.  They  may  be  due,  however,  to  injury  and  to 
accidental  causes. 

J.  L.  Down  *^  founri  ''  excessive  vaulting  of  palate  is  due  to 
arrest  of  developmc;  of  the  sphenoid  or  defective  growth  of 
the  vomer.     The  defects  are  development  defects  and  betoken 


*s  Jaws  and  Teeth  of  Semi-Barbarous  Races. 

*6  Orthodontia,  1866. 

^■^  Irregularities  and  Diseases  of  the  Teeth,   1869. 

*8  Relation  of  Teeth  and  Mouth  to  Mental  Development. 


HISTORY.  15 

a  cause  long  anterior  to  the  time  when  sucking  the  thumb  is 
practiced  unless  that  habit  be  an  intra-uterine  one. 

In  the  opinion  of  Hepburn''''  contracted  maxillae  and  alveoli 
are  the  result  of  artificial  life  and  other  causes  attendant  on  civ- 
ilization. Anthropologists  afifirm  that  with  the  advance  of  civili- 
zation there  is  decrease  in  the  size  of  the  facial  and  maxillary 
bone.  Cross-breeding  also  plays  a  part  in  producing  deformity. 
In  the  work  of  Kingsley,  irregularities  are  attributed  chiefly  to 
premature  extraction  of  temporary  teeth,  marriage  between 
persons  of  different  nationalities,  heredity  or  disturbed  inner- 
vation. 

S.  H.  Guilford^^  divides  the  causes  into  hereditary  and  ac- 
quired. Colyer^^  summarizes  the  opinions  of  the  previous  writ- 
ers into  the  statement  that  the  causes  which  produce  irregular- 
ities of  the  teeth  are  general  and  local. 

In  i90i,W.Arbuthnot  Lane^^"  called  attention  to  the  associa- 
tion of  deformities  of  the  alveolar  process  and  constitutional 
deficiencies  (like  those  of  the  chest)  referring  the  deformities  to 
the  action  of  local  factors  and  ignoring  the  underlying  constitu- 
tional element. 

Ere  the  publication  of  Kingsley's  work,  I  became  convinced 
of  the  importance  of  acquired  constitutional  as  well  as  of  factors 
of  hereditary  origin.  In  1887  I  demonstrated  before  the  Ninth 
International  Medical  Congress  the  following  propositions  by 
results  the  fruit  of  decades  of  constant  research.  The  peculiarity 
in  the  size  and  shape  of  the  jaw  bone  may  be  inherited  but  the 
manner  of  the  eruption  of  the  teeth  is  not  transmitted,  hence 
irregularities  of  the  dental  arch  per  se  are  not  inherited.  The 
muscles  of  the  cheeks  have  nothing  to  do  with  the  production 
of  the  V  or  Saddle  arch.  The  only  tissues  involved  are  the  jaw- 
bone on  the  one  hand  the  teeth  and  alveolar  process  on  the  other. 
The  incisors  in  the  V-shaped  arch  always  protrude ;  in  the  Saddle 
arch  never.  The  manner  of  the  formation  of  the  V  and  Saddle 
arches  is  in  the  arrangement  of  the  teeth.  No  matter  what  posi- 
es Irregularities  of  the  Teeth  and  Their  Treatment,  1870. 

so  Orthodontia,  1898. 

51  Irregularities  of  the  Teeth,  1900. 

siaThe  Clinical  Journal,  March  20,  1901. 


16  IRREGULARITIES    OF    THE    TEETH. 

tion  the  teeth  may  take,  the  alveolar  process  is  dependent  upon 
the  teeth  for  its  shape  and  position.  There  is  a  decided  differ- 
ence between  the  deformities  produced  by  thumb-sucking  and 
those  of  the  \  and  Saddle  arches.  Arrest  of  development  and 
excessive  growth  of  the  maxillary  bone  result  as  follows :  The 
last  but  not  least  of  the  causes  of  arrest  of  development  of  the 
maxillary  bones  is  the  influence  of  constitutional  disorders  and 
the  eruptive  diseases.  Debilitating  acute  diseases  in  children 
are  noticeably  often  followed  by  sudden  overgrowth  or  under- 
growth of  bone.  This  process  affecting  the  jaw  accounts  for  a 
certain  proportion  of  those  cases  of  pneumonia  and  measles  fol- 
lowed by  dental  irregularities  and  maxillary  deformities. 

The  relation  of  this  local  osseous  neuro-trophic  change  to  the 
neuro-pulmonary  and  neuro-cardiac  effects  of  measles  and  pneu- 
monia and  to  the  extensive  osteo-tropho-neurotic  changes  in  the 
pneumo-cardiac  type  of  acromegaly  later  described  by  Marie,  is 
evident.  Behind  both  lie  the  predisposing  factor  of  an  inherited 
or  acquired  neiyropathic  state  evinced  at  the  periods  of  stress 
marked  by  dental  evolution  or  involution. 

In  some  cases  the  process  is  a  low  grade  of  inflammation 
with  secondary  atrophy  instead  of  hypertrophy. 

Subsequently,  I  showed  that  irregularities  of  the  teeth  were 
often  due  to  two  factors.  Those  of  constitutional  origin  which 
develop  with  the  osseous  system  and  those  of  local  origin.  Irreg- 
ularities of  the  teeth  cannot  occur  until  they  have  erupted  (as 
nothing  can  exist  except  it  be  present)  anu  thus  shown  their 
relation  to  each  other  and  to  the  jaw.  The  deformity  always 
commences  at  the  sixth  year  and  is  completed  at  the  twelfth. 
Forward  movement  of  the  posterior  teeth  produce  the  same  re- 
sult as  arrest  of  development  of  the  maxillae.  It  was  also  shown^^ 
by  a  large  number  of  measurements  and  actual  cases  in  practice : 
That  the  vault  is  not  contracted  by  mouth  breathing.  That  con- 
tracted dental  arches  are  as  common  among  low  vaults  as  high 
and  that  they  simply  appear  high  because  of  the  contraction. 
That  mouth-breathing  (due  to  hypertrophy  of  the  nasal  bones 
and  mucous  membrane  deformities  of  the  nasal  bones,  adenoids 

52  Mouth  Breathing  Not  the  Cause  of  Contracted  Jaws  and  High 
Vaults,  1891. 


HISTORY.  17 

or  any  pathological  ccmdition  producing"  stenosis)  does  not  cause 
contracted  jaws,  but  all  these  conditions  are  due  to  neuroses  of 
development.  These  views  have  met  with  considerable  opposi- 
tion, yet  the  clinical  evidence  in  their  favor  has  continually 
grown.  On,  the  continent  of  Europe  their  practical  acceptance 
has  been  shown  in  the  recent  translation  by  Max  Bauchwitz^^  of 
my  work  on  the  subject. 

^2  Die  Entartiing  der  Kiefer  des  Menschengeschlechtes ;  Eine  Studie 
von  Eugene  S.  Talbot,  Uebersetzt  und  Frei  Bearbeitet  von  Max  Bauch- 
witz,  Leipzig,    1898. 


CHAPTER  II. 


HEREDITY. 

The  individual  that  comes  into  the  world  is,  as  Liiys^  remarks, 
but  one  link  in  a  long  chain  which  is  unrolled  by  time  and  the 
first  links  of  which  are  lost  in  the  dim  past.  He  has  not  merely 
two  parents  but  the  ancestors  behind  these.  These  two  parents 
may  represent  ancestors  of  very  different  type  whose  qualities 
seemingly  absent  in  the  parent  will  appear  in  their  descendant. 
The  relative  functions  of  the  sexes  in  heredity  are  moreover  a 
potent  factor  to  be  taken  into  consideration  in  estimating  its 
influence.  The  original  function  of  reproduction,  that  of  cell 
division,  is  the  part  of  the  female.  The  male  in  the  lower  types 
of  life  (some  plants  and  some  infusorise)  simply  supplies  the 
female  with  nutriment.  With  a  rise  in  evolution  protoplasm  is 
dififerentiated.  The  female  furnishes  the  type  which  is  best 
capable  of  development  when  properly  nourished  by  a  highly 
developed  male.-  As  the  product  of  fructification  is  longest 
under  the  nutritive  influence  of  the  female,  her  influence  is  most 
potent  in  redeeming  defects  or  producing  them.  'Tt  is,  there- 
fore," as  Moreau  (de  Tours^)  has  well  said,  "an  incorrect  con- 
ception of  the  law  of  heredity  that  looks  for  identical  phenomena 
in  each  succeeding  generation.  Some  have  refused  to  admit  that 
mental  faculties  were  subject  to  heredity  because  the  mental 
characters  of  the  descendants  were  not  precisely  those  of  the 
progenitors.  Each  generation  must  copy  the  preceding.  Father 
and  son  must  present  the  spectacle  of  one  being,  having  two 
births,  and  each  time  leading  the  same  life,  under  the  same  con- 
ditions. But  it  is  not  in  the  heredity  of  functions  or  of  organic 
or  intellectual  facts  that  the  application  of  the  law  of  heredity 
must  be  sought,  but  at  the  very  fountain  head  of  the  organism, 
in  its  inmost  constitution." 

1  Maladies  Mentales. 

2  Geddes-Tliomson  Evolution  of  Sex. 
2  La  Psychologie  Morbide. 

18 


HEREDITY. 


19 


Heredity,  as  I  have  elsewhere  pointed  out,'*  is  divisible  into 
direct  heredity,  indirect  heredity  and  telegony/'  The  direct 
heredity  consists  in  the  transmission  of  parental  and  maternal 
([ualities  to  the  children.  This  form  of  heredity  has  two  aspects : 
The  child  takes  after  the  father  and  mother  equally  as  regards 
both  physical  and  moral  characters,  a  case,  strictly  speaking, 
of  very  rare  occurrence ;  (2)  or  the  child,  while  taking  after  both 
parents,  more  especially  resembles  one  of  tliem.  Here  again 
distinction  must  be  made  between  two  cases.  The  first  of  these 
occurs  when  the  heredity  takes  place  in  the  same  sex  from 
father  to  son  or  from  mother  to  daughter.  The  other,  which 
is  more  frequent,  appears  when  heredity  occurs  between  different 
sexes  from  father  to  daughter  or  from  mother  to  son.  Rever- 
sional  heredity  or  atavism  consists  in  the  reproduction  in  the 
descendants  of  the  moral  or  physical  qualities  of  their  ancestors. 
It  occurs  frequently  between  grandfather  and  grandson,  as  well 
as  between  grandmother  and  granddaughter.  Collateral  or  indi- 
rect heredity,  which  is  a  rarer  occurrence  than  the  foregoing 
and  is  simply  a  form  of  atavism,  subsists,  as  indicated  by  name, 
between  individuals  and  their  ancestors  in  the  indirect  line — uncle 
or  granduncle  and  nephew,  aunt  and  niece.  Finally  there  is 
telegony  or  the  heredity  of  influence  (very  rare  from  the  physi- 
ologic point  of  view),  which  consists  in  reproduction  in  the  chil- 
dren by  a  second  marriage  of  some  peculiarity  belonging  to  a 
former  spouse. 

The  descendants  of  a  victim  of  morbidity  or  abnormality  do 
not  always  exhibit  the  morbidity  or  abnormality  of  the  ancestor. 
Sometimes  apparent  morbidity  or  abnormality  is  wanting.  In 
other  cases  slighter  abnormalities  than  those  of  the  ancestor 
are  to  be  detected.  Here  occurs  the  operation  of  two  interde- 
pendent principles.  The  transmutation  of  heredity  and  the  ata- 
vism upon  which  it  depends.  Atavism  at  times  tends  to  preserve 
the  type  and  offsets  the  influence  of  degeneracy.  It  underlies  not 
merely  the  production  of  the  sound  actions  of  degenerate  stock, 
but  also  those  in  whom  the  degeneracy  affects  the  earlier  and 
not  the  later  acquirements  of  the  race.     Manifestations  of  mor- 

■*  Degeneracy :  Its  Causes,  Signs  and  Results. 
^  Ribot  Heredity. 


20  IRREGULARITIES    OF    THE    TEETH. 

bid  heredity  may  not  be  inheritance  of  the  whole  effect  but  dis- 
turbance of  relations  of  structure,  and  hence  of  function,  pro- 
ducing a  constitutional  deficiency  which  takes  the  line  of  least 
resistance.  The  extent  and  direction  of  this  line  of  least  resist- 
ance depends  upon  the  amount  of  healthy  atavism  which  separate 
organs  and  structures  of  the  body  preserve.  What  is  true  of 
the  organism  as  a  whole  is  true  of  the  cells  forming  its  organs. 
While  cell  life  is  altruistic  or  subordinated  to  the  life  of  the 
organ  and  through  it  to  the  life  of  the  organism  as  a  whole,  still 
this  altruism  is  not  so  complete  as  to  prevent  entirely  a  struggle 
for  existence*^  on  the  part  of  the  cells  or  the  individual  organs. 
With  advance  in  evolution  this  struggle  decreases  to  increase 
with  the  opposite  procedure  of  degeneracy.  From  it  result  the 
phenomena  of  arrested  and  excessive  development.  This  strug- 
gle for  existence  was  very  early  pointed  out  by  Aristotle,'^  who 
showed  that  one  organ  was  often  sacrificed  for  the  development 
of  another.  This  was  more  clearly  pointed  out  and  freed  from 
obscurity  by  Goethe  in  1807  and  St.  Hilaire  in  1818.  The  law 
under  which  this  struggle  operates  is  known  as  the  law  of  econ- 
omy of  growth.  Its  action  sometimes  aids,  sometimes,  when 
regular,  prevents,  degeneracy.  As  has  been  pointed  out  by 
Von  Baer,  the  vertebrate  embryo  of  the  higher  type  has  in  it 
all  the  potentialities  for  the  organs  and  structures  found  in 
lower  types.  Therefore  in  proportion  as  the  ancestry  is  strength- 
ened do  these  potentialities  remain  latent.  On  the  other  hand, 
in  proportion  as  the  ancestry  becomes  a  subject  of  nervous 
exhaustion  these  potentialities  gain  nutrition  at  the  expense 
of  the  later  acquired  organs  which  are  the  ones  likely  to  be 
afifected  by  nervous  exhaustion.  All  the  organs  of  the  body  have 
practically  their  own  nervous  system,  which  exercises  a  control 
over  their  nutrition  through  its  control  over  the  blood  supply 
and  the  means  of  excretion.  The  excessive  action  of  this  local 
nervous  system  is  regulated  by  the  central  nervous  system  for 
the  benefit  of  the  organism  as  a  whole.  Should  the  central 
nervous  system  become  weakened,  the  local  nervous  system, 
given  free  play,  first  draws  greater  nourishment  and  increased 

^  Roux  Dcr  Kamp  der  Theile  im  Organismus. 
■^  Osborn,  From  the  Greeks  to  Darwin. 


HEREDITY.  21 

power  at  the  expense  of  other  organs.  As  a  result  of  this 
increased  power  the  local  nervous  system  becomes  itself 
exhausted  and  a  struggle  for  existence  occurs  between  its 
parts.  In  consequence,  as  in  the  case  of  tumors  and  cancers, 
cells  take  on  the  power  of  reproduction,  which  for  a  long  time 
they  had  lost,  for  the  benefit  of  the  organization  as  a  whole.^ 
This  strugle  for  existence  produces  effects  which  are  handed 
down  by  heredity  or  are  fought  by  atavism  ("throwback,"  in  the 
language  of  the  cattle  breeders),  as  the  tendency  to  return  to  the 
type  of  a  more  remote  ancestor  is  called.  It  is  obvious,  there- 
fore, that  these  two  factors  in  heredity  may  play  beneficial  as 
well  as  injurious  parts  on  the  ofifspring.  As  a  rule  atavism  plays 
a  beneficial  part  in  correcting  degenerate  tendencies.  This 
part  may  either  be  complete  in  the  shape  of  a  perfect  return  to 
a  normal  ancestor  or  may  be  so  incomplete  as  to  moderate  in 
in  the  ofifspring  the  extended  nervous  exhaustion  which  an  ances- 
tor has  transmitted. 

As  shown  by  Moreau  (de  Tours),  the  biologic  effects  of 
degenerative  forces  on  heredity  are  as  follows :  First,  absence 
of  conception ;  second,  retardation  of  conception ;  third,  imper- 
fect conception ;  fourth,  incomplete  products  (monstrosities) ; 
fifth,  products  whose  mental,  moral  and  physical  constitution 
is  imperfect ;  sixth,  products  specially  exposed  to  nervous  dis- 
orders in  order  of  frequency  as  follows :  Epilepsy,  imbecility, 
idiocy,  deaf-mutism,  insanity,  and  other  cerebral  disorders ;  sev- 
enth, lymphatic  products  predisposed  to  tuberculosis  and  allied 
disorders ;  eighth,  products  which  die  in  infancy  in  a  greater 
proportion  than  sound  infants  under  the  same  conditions;  ninth, 
products  which,  although  they  escape  the  stress  of  infancy,  are 
less  adapted  than  others  to  resist  disease  and  death.  These 
varied  results  are  due  to  the  biologic  law  that,  ?s  Herbert 
Spencer  has  shown,  with  increase  in  growth  and  specialization 
must  occur  decrease  in  the  explosive  manifestations  of  life. 
Among  these  explosive  manifestations  in  early  biologic  history 
is  the  function  of  reproduction  which  is  common  to  all  cells. 
With  advance  in  evolution  the  functions  of  cells  become  special- 
ized and  the  extent  of  reproductive  power  is  decreased.     This 

8  Degeneracy,  Op.  Cit. 


22  IRREGULARITIES    OF    THE    TEETH. 

specialization,  Spencer  designates  individuation.    In  degeneracy 
the  organism  returns  to  the  lower  type  and  consequently  tends 
to   a   reversion  of   individuation.     In   consequence  first  occurs 
the  absence  of  conception  to  which  Moreau  de  Tours  refers. 
If  the   organism   be    less    deeply   affected,   the   plural  and   fre- 
quently repeated  births  of  degenerates  occiu\     Abortions   are 
comparatively  more  frequent  in  plural  than  in  ordinary  preg- 
nancies.   Monstrosities  of  all  kinds  are  commoner  in  plural  than 
in  ordinary  pregnancies.     There  are  more  dead  born  children 
in   plural  ~  pregnancies,   and   the   children   born   alive   are   more 
difficult  to  rear.    The  proportion,  according  to  Ansell,^  of  infants 
that  are  still  born  or  die  soon  after  birth  is  in  the  case  of  males 
nearly  five  times  and  in  the  case  of  females  nearly  four  times 
greater  in  multiple  than  in  single  births.     Pluriparity,  accord- 
ing to  J.  M.  Duncan,  is  especially  associated  with  idiocy  and 
imbecility,  and  it  especially  affects  the  sterile  ages  or  the  ages 
of  weakness  of  reproduction.     According  to  Arthur  Mitchell,^^ 
among  imbeciles  and  idiots  a  much  larger  proportion  is  found 
to  be  twin-born  than  among  the  general  community.     Among 
relatives  of  imbeciles  and  idiots  twinning  is  very  frequent.     In 
families  where  twinning  is  frequent,  bodily  deformities  (of  defect 
and  of  excess)  likewise  occur  with  frequency.    The  whole  history 
of  twin  births  is  exceptional,   indicates  imperfect  development 
and  feeble  organization  of  the  product  and  tends  to  show  that 
twinning  in  man  is  a  dcpartiuT  from  the  phvsiologic  rule,  and 
hence  injiu-ious  to  all  concerned.     Everything  known  concern- 
ing triplets   and    quadruplets    supports    opinions    derived    from 
twins.     Valenta   had   under   observation   two  epileptics    (mother 
and  daughter),  who  illustrated  this  very  decidedly.    The  mother 
had  thirty-eight  children,  six  times  twins,  four  times  triplets  and 
twice    quadruplets.      The    daughter,    at   the    age    of   forty,   had 
thirty-two    children :       three    times    twins,    six    times    triplets 
and  twice  quadruplets.     Ninety  families  of  degenerates  coming 
under    Kiernan's    observation^^    averaged    eleven    children    each. 
Triplets,   quadruplets   and  twins  were  more  than  ten  times  as 

»  Gaillard's  Medical  Journal,  May  I2th.  18,^3. 
10  Medical  Time';  and  Gazette,  Nov.  15th,  1862. 
^^  Alienist  and  Neurologist,  1901. 


HKREDITY.  23 

frequent  as  among-  the  population  taken  as  a  whole.  The 
ocurrcnce  of  large  families,  as  Kiernan  remarks,  should  hence 
be  regarded  not  as  an  expression  of  advance  but  as  an  expres- 
sion of  degeneracy.  Teachings  entirely  too  prevalent  as  to  status 
in  evolution  being  determined  by  progeny  have  cultivated  a 
factor  of  degeneracy  which,  when  it  occurs  in  a  family,  must 
be  regarded  as  merely  a  transformation  of  malign  heredity.' - 

From  these  conflicting  factors  it  results  that  direct  heredity 
is  rare  and  that  acquired  influences  are  apt  to  expend  their 
force  upon  unstable  structures  most  subject  to  the  struggle  for 
existence  occurring  within  the  organism.  The  skull,  jaws  and 
teeth  are  predisposed  to  this  struggle  and  hence  peculiarly  liable 
to  the  ply  of  hereditary  influences  or  acquired  defects  of  an 
ancestor. 

Heredity  hence  usually  furnishes  in  the  case  of  the  jaws  and 
teeth  merely  powder  to  be  lighted  up  by  factors  locally  applied 
during  the  periods  of  stress  after  birth.  Without  these  locally 
applied  excitants,  the  types  usually  ascribed  to  heredity  by  dent- 
ists will  not  occur.  Environment  furnishes  the  match  but  it 
makes  a  great  difference  whether,  as  Havelock  Ellis  says,  the 
match  be  thrown  into  a  powder  magazine  or  the  sea. 

No  discussion  of  heredity  is  complete  without  reference  to  the 
position  of  the  biologist,  Weismann,^^  who  (basing  his  opinion 
upon  an  alleged  distinction  between  what  he  calls  the  body  plasm 
and  the  germ  plasm),  denies  the  inheritance  of  acquired  defects. 
An  attempt,  however,  to  transfer  his  position  from  the  domain 
of  biology  tO'  that  of  pathology  led  him  to  encounter  facts  he 
was  obliged  to  explain  in  a  manner  inconsistent  with  his  original 
position.  In  his  last  work,^'*  he  advances  the  opinion  that  "the 
origin  of  a  variation  equally  independent  of  selection  and  amphi- 
mixis is  due  to  the  constant  occurrence  of  slight  inequalities  of 
nutrition  in  the  germ  plasm.  These  variations  are  at  first  infini- 
tesimal but  may  accunnilate,  and  in  fact  they  must  do  so  when  the 
modified  conditions  of  nutrition  which  gave  rise  to  them  have 
l-icfed  for  several  generations.     But  although  it  is  improbable 

12  Degeneracy,   Op.  Cit. 

13  Essays  upon  Heredity. 

!■*  The  Germ  Plasm.  > 


24  IRREGULARITIES    OF    THE    TEETH. 

that  individual  variability  can  depend  on  a  direct  action  of 
external  influence  upon  the  germ  cells  and  their  contained  germ 
plasm  must  be  very  difficult  to  change,  yet  it  is  by  no  means 
to  be  implied  that  this  structure  may  not  possibly  be  altered 
by  influences  of  the  same  kind  continuing  for  a  very  long  time. 
Thus  much  may  be  maintained  that  influences  which  are  mostly 
of  variable  nature  tending  now  in  one  direction,  now  in  another, 
can  hardly  produce  a  change  in  the  structure  of  the  germ  plasm, 
and  this  is  the  reason  why  the  cause  of  inheritable  individual 
difference  must  be  sought  elsewhere  than  in  these  varying  influ- 
ences." "No  one  has  doubted,"  he  says,  in  response  to  Vir- 
chow,  "that  there  are  a  number  of  congenital  deformities,  birth- 
marks and  other  individual  peculiarities  which  are  inherited." 
But  these  are  accjuired  characters  in  the  above  sense.  True,  they 
must  have  once  appeared  for  the  first  time,  but  we  cannot 
say  exactly  from  what  cause ;  we  only  know  that  at  least  a  great 
proportion  of  them  proceed  from  the  germ  itself  and  must 
therefore  be  due  to  alteration  of  the  germinal  substance.  If 
Virchow  could  show  that  any  single  one  of  these  hereditary 
deformities  had  its  origin  in  the  action  of  some  external  cause 
upon  the  already  formed  body  (soma)  of  the  individual  and 
not  upon  the  germ  cell,  then  the  inheritance  of  acquired  char- 
acters would  be  proven.  Rut  this  no  one  has  yet  succeeded  in 
proving,  often  as  it  has  been  maintained.  Weismann,  however, 
deals  a  coup  de  grace  to  his  own  position  by  admitting  that 
tuberculosis  may  produce  what  he  calls  a  "habit  in  the  ancestor 
which  may  be  transmitted  to  the  descendants.  This  habit  con- 
sists in  the  formation  of  structural  peculiarities  such  as  narrow- 
ness of  the  chest,  etc."  The  admission  of  such  a  "habit"  oflfsets 
any  denial  of  the  inheritance  of  acquired  characters.  Some 
recent  investigations  in  the  laboratory  of  the  Naples  Aquarium^ ^ 
have  destroyed  the  embryologic  distinction  between  the  germ 
plasm  and  the  body  plasm.  Weismann's  claim  that  the  first 
division  of  the  cell  represented  separation  of  body  plasm  and 
germ  plasm  is  contradicted  by  these  experiments.  Not  only 
when  the  cell  has  divided  twice,  but  four  times  and  even  six- 
teen times,  can  the  separate  cells,  if  dissociated  from  the  group, 

^•^  Alienist  and  Neurologist,  July,  igoo. 


HKRKUITY. 


pursue  a  separate  existence  and  become  well  developed  organ- 
isms of  the  parent  type.  Experiments  in  the  production  of 
double  monsters  by  1'^  C.  Spitzka,  Dareste  and  others,^''  had 
long  ago  cast  suspicion  upon  the  embryologic  position  of  Weis- 
mann.  His  criticisms,  however,  have  done  undeniable  good  in 
destroying  loose  notions  as  to  direct  heredity  previously  present. 
^•5  Lectures  on  Eniljrvologv,  St.  Louis  Clinical  Record,   1879-1881. 


CHAPTER   III. 


CONGENITAL  FACTORS  AND   MATERNAL  IMPRES- 
SIONS. 

Hereditary  influences  must  be  separated  from  factors  occur- 
ring during  one  pregnancy  which  affect  the  product  of  that  preg- 
nancy alone.  Prominent  among  these  factors  are  the  "maternal 
impressions  or  so-called  mother's  marks." 

A  striking  illustration  of  "maternal  impressions"  among 
animals  was  reported  nearly  two  decades  ago  by  T.  C.  Poole/ 
of  Mansfield,  Texas.  His  sow  gave  birth  (April,  1883,)  to  eight 
fully  developed  pigs.  The  ninth  had  the  appearance  of  an  ele- 
phant. It  was  destitute  of  hair,  had  dependent  ears,  a  proboscis, 
two  eyes  behind  upper  two  thirds  of  proboscis,  closely  approxi- 
mated, yet  distinct,  an  abnormal  superior  maxillary,  containing 
three  large  teeth,  with  a  long,  thin  upper  lip  of  elephantine 
shape  and  color.  The  sow's  gestation  lasts  three  months  and 
twenty  days.  On  Christmas  day,  1882,  the  boar  was  with  her. 
December  29th,  a  menagerie  had  an  elephant  staked  about  three 
hundred  yards  from  where  the  sow  was  and  in  full  view. 

J.  G.  Kiernan,-  commenting  on  this  case,  pointed  out  that 
the  pig,  descending  from  the  proboscidse,  has  at  one  stage  in 
intra-uterine  development  a  proboscis  whose  musculature  is 
still  retained  by  the  adult  pig,  in  whom  the  nose  plays  to  some 
extent  the  part  of  a  hand  for  rooting  purposes.  The  case  was, 
therefore,  due  to  arrested  development  at  the  period  of  pig  intra- 
uterine development  when  the  proboscis  existed.  This  arrested 
development  could  have  arisen  from  nervous  shock  to  the  sow, 
alleged  since  these  animals  are  easily  upset  during  gestation. 

Maternal  impressions  have  (as  Kiernan  remarked  in  a  dis- 
cussion before  the  Chicago  Academy  of  Medicine),-"^  been  con- 
sidered from  one  standpoint  only  and  that  is  as  to  their  supposed 
cause   and   its    method   of  action.     As   the   supposed    cause   is 

1  Gaillard's  Medical  Journal,  Vol.  36,  No.  i,  1883. 

2  Gaillard's  Medical  Journal,  July  7th,  1883. 

3  Medicine,  May,  1900.  ,  . 

26 


CONGENITAL    FACTORS    AND    MATERNAL    IMTRESSIONS.  27 

psychic  and — in  the  conception  of  it  usually  adopted — imma- 
terial in  action,  an  absurd  credulity  respecting  its  powers,  which 
existed  at  one  time  among  obstetricians,  has  given  way  to  an 
equally  absurd  skepticism.  The  subject  has  not  been  discussed 
by  either  set  of  partisans,  from  a  scientifically  critical  standpoint. 
This  skeptical  spirit  has  evinced  itself  in  denial  of  a  case  authenti- 
cated by  embryologists  and  ornithologists  of  unblemished  repute 
and  further  supported  by  teratologic  specimens  in  the  British 
Museum.  Spitzka  had  his  skepticism  as  to  maternal  impressions 
shaken  by  these  specimens,  which  were  newly  hatched  chicks 
with  a  curved  beak  like  a  parrot  and  the  toe  set  back  as  in  that 
bird.  The  hens  in  the  yard  where  these  monstrosities  were 
hatched  had  been  frightened  by  a  female  parrot  which,  having 
escaped,  fluttered  among  them  before  the  eggs  were  laid  and 
E^reatly  frightened  the  hens  from  whose  eggs  the  malformed 
chicks  were  hatched.  This  would  seem  at  first  sight  to  confirm 
the  photographic  theory  of  maternal  impressions.  These  mal- 
formations are,  however,  as  in  the  case  of  the  pig,  simply  arrests 
of  development.  Birds  are  aberrant  reptiles  belonging  to  the 
sauropsidge,  and  during  their  embryonic  development  pass 
through  a  reptilian  phase.  It  was  at  the  end  of  this  phase  that 
the  chicks  were  arrested  in  development,  producing  the  parrot- 
like  malformation.  For  lack  of  logical  explanations  like  these, 
modern  obstetricians  are  skeptical.  In  a  general  way,  alleged 
maternal  impressions  may  be  divided  into  two  classes  :  t.  Those 
in  which  an  arrest  of  embryonic  development  has  occurred, 
which  may  or  may  not  be  traceable  to  the  alleged  impression. 
2.  Photographic  impressions  charged  to  a  factor  utterly  inca- 
pable of  producing  them  because  of  the  later  period  in  embry- 
onic life  at  which  the  impression  is  alleged  to  have  acted. 

The  fact  that  mental  shocks  can  only  act  on  the  organization 
in  a  purely  physical  manner  is  equally  ignored  by  opponents 
and  advocates  of  the  psychic  theory  of  mental  impressions.  All 
that  is  known  of  the  mind  is  known  of  it  as  related  to  purely 
physical  conditions.  It  is  through  pure  physical  conditions  that 
it  must  act,  whether  its  action  be  initiated  by  conditions  affecting 
physically  the  various  sense  organs  or  not. 

There  is  no  doubt  that  the  foetus  is  liable  to  mental  effects 


28  IRREGULARITIES    OF    THE    TEETH. 

from  the  mother,  since,  as  Fere*  has  shown,  it  often  exhibits 
very  decided  reaction  to  sensory  impressions  on  the  mother. 
Women  in  the  midst  of  an  ordinary  dream,  producing  but  very 
moderate  excitations  not  generally  interrupting  sleep,  are  often 
awakened  by  foetal  movements.  These  dreams  need  have  noth- 
ing of  the  nightmare  which  would  cause  sudden  contraction 
under  the  influence  of  a  terrifying  idea  with  its  resultant  cardiac 
disorder.  They  may  be  merely  the  ordinary  phenomena  of  sleep. 
Mental  changes  of  the  mother  hence  excite  motor  reaction  in  the 
foetus  and,  as  with  sensorial  excitations,  these  reactions  are 
stronger  in  the  foetus  than  in  the  mother.  The  mechanism  c 
these  motor  reactions  is  obviously  the  unconscious  and  invol- 
imtary  movement  of  the  uterine  walls.  A.  Lagorio,-''  some  sev- 
enteen years  ago,  brought  before  the  Chicago  Medical  Society 
several  cases  in  which  maternal  impressions  had  produced  decid- 
edly abnormal  births  with  deformities  resembling  those  feared 
by  the  mother.  In  discussing  these  Kiernan  pointed  out  that 
they  were  all  instances  of  checked  development  and  advanced 
the  opinion  that  normal  shock  generally  played  the  chief  part 
in  maternal  impressions  through  checking  development  and 
causing  either  general  or  local  reversion.  Here  the  statistic 
method  can  be  applied.  Of  92  children  born  in  Paris  during 
its  last  seige,  64  had  slight  mental  or  physical  anomalies.  The 
remaining  28  were  all  weakly;  21  were  imbecile  or  idiotic  and 
8  were  moraUy  insane.  These  figures  of  Legrande  du  Saulle 
justify  the  characterization  by  the  working  class  of  Paris  of 
children  born  in  1871  as  "doomed  children."  In  Berlin  the 
financial  crisis  of  1 875-1 880  was  followed  by  an  increase  in  the 
number  of  idiots  born.  It  must  be  remembered  that  profound 
mental  shock  can  alter  nutrition  so  that  the  mother  shall  furnish 
poisonous  products  in  lieu  of  nutriment.  That  such  poisonous 
products  would  tend  to  check  foetal  development  no  one  will 
deny. 

Therefore,  while  science  rejects  the  photographic  phase  of 
maternal  impressions,  it  admits  that  a  class  of  cases  of  arrested 

*  Sensation  et  Mouvement. 

s  Chicago  Medical  Journal  and  Examiner,  1883-84. 


CONGENITAL    FACTORS    AND    MATERNAL    IMPRESSIONS.  29 

development  exists,  due  to  the  effects  of  mental  shock  upon  the 
mother. 

The  inlUience  of  maternal  impressions  would  he  most  strongly 
exerted  on  structures  variahle  in  evolution.  This  iniluence 
must,  hence,  strongly  affect  nutrition  of  the  dermal  bone  ele- 
ments of  the  skull,  face  and  jaws,  and  hence  must  affect  the 
teeth.  The  results  of  this  will  not  always  be  obvious  until  the 
periods  of  stress. 

One  expression  of  foetal  senescence  is  the  production  of  chil- 
dren born  with  teeth.  This  often  occurs,  however,  under  the 
law  of  economy  of  growth  in  connection  with  arrested  devel- 
opment elsewhere.  Cyclops  and  similar  grave  types  of  degen- 
eracy are  frequently  accompanied  with  premature  eruption  or 
development  of  the  teeth.  The  connection  between  degeneracy 
and  teeth  at  birth  must  have  been  very  early  observed,  since 
Shakespeare  makes  Richard  III  remark, 

"The  midwife  wonder'd  and  the  woman  cried, 

'O  Jesu,  bless  us,   he  is  born  with  teeth,   . 

And  so  I  was ;  which  plainly  signified 

That  I  should  snarl  and  bite  and  play  the  dog." 

Ante-natal  teeth  are  far  from  rare  and  as  Gould*'  remarks, 

the   significance   of   such   eruption   of   teeth    is   not  always  that 

of  vigor,  since  many  of  the  subjects  succumb  early  in  Hfe.    Pliny, 

Columbus,   Van    Swieten,    Haller,    Marcellus    Donatus,   Baude- 

loque,  Cazeaux,  Soemmering  and  Gardien  cite  instances  in  which 

children  have  been  born  with  teeth  already  erupted.    Haller  has 

collected  19  cases  of  children  born  with  teeth.    Polyderus  Virgi- 

lus  describes  an  infant  who  was  born  w'ith  six  teeth.    Louis  XIV 

had  two  teeth  at  birth.     Bigot,  a  medical   philosopher  of  the 

sixteenth   century,   Boyd   the   poet,  Valerian,   as   well  as   some 

ancient  Greeks  and  Romans,  had  this  anomaly.   There  were  two 

cases  typical  of  foetal  dentition  shown  before  the  Academic  de 

Medecine  de  Paris.    One  of  die  subjects  had  two  central  incisors 

of  the  lower  jaw  and  the  other  had  one  tooth  well  through.    Levi- 

son  saw  a  female  born  with  two  central  incisors  in  the  lower 

jaw. 

•^  Anomalies. 


CHAPTER   IV. 


POST-NATAL  SKULL  AND  JAW  DEVELOPMENT  AND 
PERIODS  OF  STRESS. 

The  assumption  that  the  child  is  simply  an  immature  man 
or  woman  is,  as  has  been  shown  by  biologists,  a  far  too  prevalent 
error.  The  child,  with  its  relatively  enormous  head,  its  large 
protuberant  abdomen — "all  brain  and  belly,"  as  some  one  defines 
it — its  small  chest,  short,  feeble  legs,  comparatively  vigorous 
arms,  smooth,  almost  hairless  skin,  large  liver,  kidneys,  thymus 
and  suprarenal  capsules  presents,  as  Havelock  ElHs^  remarks, 
a  distinct  anatomic  picture.  The  facts  of  the  child's  physi- 
ologic and  psychic  life  are  clear  indications  in  the  same  direction. 
The  anthropoid  apes  at  an  early  period  of  life  often  present 
characters  quite  unlike  those  of  the  adult.  While  the  young 
anthropoid  is  comparatively  human,  the  adult  ape  is  compara- 
tively bestial  in  character.  The  young  ape  has  a  smooth  globular 
head  and  relatively  small  face,  like  man.  The  profile  is  more 
human  with  little  prognathism.  The  base  of  the  skull  is  formed 
in  a  more  human  way  than  in  the  adult  ape.  The  brain  is  rela- 
tively very  much  larger  than  in  the  adult.  In  the  gorilla,  for 
example,  the  foetus  difTers  from  the  adult  by  having  relatively 
a  much  larger  head,  a  longer  neck,  a  more  slender  trunk,  shorter 
thumb  and  great  toe;  while  the  head  is  more  globular,  the  face 
less  prognathous  and  the  hand  more  man  like.  In  nearly  all 
these  characters,  the  foetal  gorilla  approaches  man.  The  adult 
male  ape  rapidly  develops  into  a  condition  far  removed  from  his 
early  man-like  state.  The  brain  becomes  relatively  very  small, 
the  receding  skull  becomes  hideous  with  huge  bony  crests,  sharp 
angles  and  on  its  enormously  enlarged  facial  portions,  promi- 
nent outstanding  superciliary  ridges,  projecting  jaws  and  reced- 
ing chin,  while  the  dark  hairy  body  becomes  more  bestial  in 
character.  The  female  ape  remains  midway  between  the  infantile 
and  the  adult  male  condition.  So  far  as  man  is  ape-like  it  is 
the  infantile  and  not  the  adult  whom  he  resembles.     Man  in 

1  Man  and  Woman. 

30 


POST-NATAL    SKUI.L     AN'D    JAW    DKVKLOl'MENT.  31 

the  course,  of  his  hfe  [alls  away  more  and  more  from  the  specific- 
ally human  type  of  his  early  years,  but  the  ape  in  the  course  of  his 
short  life  goes  very  much  farther  along  the  road  of  degradation 
and  premature  senility.  The  ape  starts  in  life  with  a  considerable 
human  endowment,  but  in  the  course  of  life  falls  far  away  from 
it.  Man  starts  in  life  with  a  still  greater  portion  of  human  or 
ultra  human  endowment  and  to  a  less  extent  falls  from  it  in  adult 
life,  approaching  more  and  more  to  the  ape.  Up  to  birth  or 
shortly  afterwards  in  the  higher  animals,  such  as  the  apes  and 
man,  there  is  a  rapid  and  vigorous  movement  along  the  line 
upward  in  zoologic  evolution.  A  time  comes,  however,  wdien 
this  fretal  or  infantile  development,  ceasing  to  be  upward,  is  so 
directed  as  to  answer  to  the  life  wants  of  the  particular  species. 
Henceforth  and  throughout  life  there  is  chiefly  a  development 
of  lower  characters,  a  slow  movement  towards  degeneration  and 
senility,  although  one  absolutely  necessary  to  insure  the  preser- 
vation and  stability  of  the  individual  and  species. 

FcEtal  evolution,  which  takes  place  sheltered  from  the  world, 
is  in  an  abstractly  upward  direction.  After  birth  further  devel- 
opment is  a  concrete  adaptation  to  the  environment  without 
regard  to  upward  zoologic  movement.  The  infantile  condition  in 
both  ape  and  man  is  somewhat  alike  and  approximates  to  the 
human  condition.  The  adult  condition  of  both  also  tends  to  be 
somewhat  alike  and  approximates  to  the  ape-like  condition. 

The  human  infant  presents  in  an  exaggerated  form  the  chief 
distinctive  characteristics  of  humanity,  the  large  head  and  brain, 
the  small  face,  the  hairlessness,  the  delicate  bony  system.  By 
some  strange  confusion  of  thought,  this  fact  is  usually  ignored 
and  it  is  assumed  that  the  adult  form  is  more  highly  developed 
than  the  infantile  form.  From  the  standpoint  of  adaption  to 
environment,  the  coarse,  hairy,  large-boned  and  small-brained 
gorilla  is  better  fitted  to  make  his  way  in  the  w^orld  than  the 
delicate  offspring,  but  from  a  zoologic  point  of  view  anything 
but  progress  occurs.  In  man,  from  about  the  third  year  on\vard, 
further  growth,  though  absolutely  necessary  adaption  to  the 
environment,  is  to  some  extent  growth  in  degeneration  and  senil- 
ity. It  is  not  carried  to  so  low  a  degree  as  in  the  apes,  although 
by  it  man  is  to  some  extent  brought  nearer  to  the  apes.  Among 
the  higher  human  races  the   progress  toward  senility  is  less 


32 


IRREGULARITIES    OF     THE    TEETH. 


marked  than  among  the  lower  human  races.  The  child  of  many 
African  races  is  scarcely,  if  at  all,  less  intelligent  than  the  Euro- 
pean child.  The  African,  as  he  grows  up,  however,  becomes 
stupid  and  obtuse  and  his  whole  social  life  falls  into  a  state  of 

hide-lK)und  routine.     The  European  retains  much  of  his  child- 


tig.  I. 
like  vivacity.     The  highest  human  types  represented  in  typical 
men  of  genius  are  a  striking  approximation  to  the  child  type. 

The  contrast  between  the  prophecy  of  development  in  the 
child  and  its  fulfillment  in  the  adult  is  excellently  depicted  in 
the  above  illustration   (Fig.    i)   modified  from   Havelock  Ellis. - 

2  Man  and  Woman. 


POST-NATAL    SKULI,    AND    JAW     DEVELOPMKNT.  33 

The  great  factors  in  the  environment  which  interrupt  race  up- 
ward progress  are  as  Kicrnan-'  points  out,  the  periods  of  stress. 
While  even  the  last  of  these  presents  as  its  most  obvious  feature 
dentitional  evidences,  still  in  all,  important  processes  of  nutrition 
and  reproduction  are  involved. 

Every  vertebrate,  as  I  pointed  out  some  years  ago,'*  is  an 
aggregate  whose  internal  actions  are  adapted  to  counterbalance 
its  external  actions.  Hence  preservation  of  its  movable  equi- 
librium depends  upon  its  development  and  the  proper  number  of 
these  actions.  The  movable  equilibrium  may  be  ruined  when 
one  of  these  actions  is  too  great  or  too  small  and  through 
deficiency  or  need  of  some  organic  or  inorganic  cause  in  its 
surroundings.  Every  individual  can  adapt  itself  to  these  change- 
able influences  in  two  ways,  either  directly  or  by  producing  new 
individuals  who  will  take  the  place  of  those  in  whom  the  equi- 
librium has  been  destroyed.  Therefore,  forces  exist  preserva- 
tive and  destructive  to  the  race.  Since  it  is  impossible  that 
these  two  varieties  of  force  should  counterbalance  each  other, 
it  is  necessary  that  the  equilibrium  should  re-establish  itself  in 
an  orderly  way.  Since  these  are  two  preservative  forces  of  every 
animal  group — the  impulse  of  every  individual  to  self-preserva- 
tion and  the  impulse  to  the  production  to  other  individuals — 
these  faculties  must  vary  in  an  inverse  ratio  and  the  former 
must  diminish  when  the  second  increases.  Degeneration  con- 
stitutes a  process  of  disintegration.  Hence  if  the  term  "individu- 
ation" be  applied  to  all  the  processes  which  complete  and  sustain 
the  life  of  the  individual,  and  that  of  "generation,"  to  those 
which  aid  the  formation  and  development  of  new  individuals. 
Individuation  and  generation  are  necessarily  antagonistic,  as 
Herbert  Spencer'^  has  shown. 

Vertebrate  embryos,  all  of  common  type  at  their  origin, 
assume,  as  Von  Baer  has  demonstrated  successively,  a  number 
of  common  forms  before  definitely  dififerentiating.  Supernumer- 
ary organs,  as  Dareste  has  shown,  exist  in  these  common  forms 
at  one  phase  of  embryonic  life.     This  community  of  embryonic 

3  Child  Study  Magazine,  1898. 
*  Degeneracy,  Op.  Cit. 
^  Principles  of  Biology. 
4 


34  IRREGULARITIES    OF    THE    TEETH. 

types  and  this  last  fact,  explains  repetition  of  teratologic  types 
in  vertebrates.  This  community  of  origin,  moreover,  indicates 
that  the  higher  vertebrate  embryo  contains  in  essence  the  organs 
and  potentialities  of  all  the  lower  vertebrates,  and  that  under 
the  influence  of  heredity  or  accidental  defect  an  organ  or  struct- 
ure or  function  constant  in  a  species  may  be  lacking  in  an  indi- 
vidual without  the  necessity  of  explaining  the  iihmediate  effects 
by  distant  atavism. 

Varying  conditions  must  stimulate  these  embryologic  poten- 
tialities at  the  expense  of  the  later  acquired  and  more  typic 
human  organs.  The  Cohnheim  theory  of  cancer  is  an  application 
of  this  principle.*^  From  this  results  a  struggle  for  existence 
on  the  part  of  organs  and  structures  which,  early  observed  by 
Aristotle,  Goethe  and  St.  Hilaire,  was  forcibly  shown  by  Roux" 
two  decades  ago,  who,  while  admitting  determination  by  hered- 
ity, pointed  out  that  there  are  always  surrounding  forces  neces- 
sary, not  simply  the  condition  of  activity  by  an  essential  element 
of  the  final  product.  He  thus  harmonizes  the  extreme  views  by 
an  internal  or  physiologic  struggle  for  existence  between  the 
organs,  the  cells  and  protoplasmic  molecules  of  the  organism. 
This  unsimilarity  of  parts  makes  it  impossible  to  establish  laws 
of  heredity  which  shall  govern  details  of  function  as  to  the  last 
cell  or  molecule  since  in  any  army  the  commander-in-chief  does 
not  give  a  special  order  beforehand  affecting  every  private  in 
the  ranks.  Ther^  must  be  potentiality  of  adaptation  to  sur- 
roundings, especially  in  details,  which  are  more  easily  changed 
than  events  on  a  larger  scale. 

The  principle  that  lies  back  of  all  development  of  tissues  and 
organs  is  over  compensation  of  what  is  used,  a  quality  which 
permits  self-regulation  and  is  rarely  a  necessary  precondition  of 
life.  Living  matter  presents  an  external  continuity  in  spite  of 
change  of  condition.  To  effect  this,  assimilation  must  always  be 
in  excess  (over-stimulation)  for  if  less  than  consumption,  the 
organism  comes  to  an  end  itself.  If  equal  conditions  result, 
change  and  nourishment  will  fail  or  injurious  events  will  cause 


^  Kiernan    (Editorial  Journal  of  American  Medical  Association,  Vol. 
XXXI). 

7  Op.  Cit. 


I'OSr-NATAL    SKUI-I,    AND    JAW    DEVFI.OPMENT.  35 

destruction.  Continuance  can  only  be  assured  when  more  is 
assimilated  than  is  consumed.  Fire,  for  example,  assimilates  more 
than  it  uses,  i.  e.,  it  always  has  energy  left  over  to  kindle  new 
material.  Fire  would,  like  life,  become  external  if  it  did  not  use 
up  material  quicker  than  other  processes  can  make  them.  In- 
the  same  way  organisms  assimilate  more  than  they  can  con- 
sume, but  they  do  not  turn  all  they  use  to  assimilation ;  energy 
remains  over  by  which  the  process  performs  some  thing.  This 
work  product  controls  the  excessive  assimilation  which  other- 
wise would  come  to  an  end  by  not  having  sufficient  material  to 
assimilate.  The  more  complex  processes  of  life  are,  hence, 
essentially  as  Colin  A.  Scott^  remarks,  a  radiation  of  assimilation 
which,  although  not  identical  with  combustion,  is  similar  to  it ; 
the  load  which  it  carries  favoring  its  continuity.  This  radiation, 
load  or  over  product  becomes  directed  by  natural  selection  to 
keep  up  a  supply  of  food  primarily  by  moving  the  assimilating 
mass.  Performance  of  function  over  and  above  assimilation  is 
just  as  much  a  condition  of  continuous  assimilation  as  assimila- 
tion is  of  performance.  On  the  other  hand,  there  comes  to  be 
an  inverse  relationship  between  growth  and  product  (within 
limits)  and  capacities  result  which,  although  they  use  up  material, 
do  not  in  themselves  increase  assimilation.  The  course  of  devel- 
opment consists  in  properly  directing  the  work  products.  This 
so  far  represents  merely  a  continuous  productibility  of  function 
in  connection  with  assimilation.  But  a  productibility  which  is 
stored  up  and  discharged  by  an  outer  stimulus  of  environment 
will  be  much  more  economic  and  will  give  rise  to  w^hat  we  find  as 
reflex  excitability.  When  this  reflex  product  dominates,  accord- 
ing to  circumstances,  function  will  sometimes  be  greater  and 
sometimes  less.  If,  under  these  conditions,  assimilation  keeps 
on  continuously,  there  must  sometimes  be  an  overplus,  some- 
times a  balance  and  sometimes  an  excessive  function,  death  and 
thus  elimination.  To  avoid  this  last,  it  is  necessary  that  assimila- 
tion should  depend  upon  use  or  upon  a  stimulus,  which  use  calls 
forth.  From  the  psychic  side  stimulus  is  recognized  as  hunger. 
This  kind  of  process  where  stimulus  is  an  indispensable  factor 
is  more  special  and  limited  than  the  more  general  process  of 

8  American   Psychological  Journal,  1888. 


36  IRREGULARITIES    OF    THE    TEETH. 

assimilation  plus  movement,  etc..  but  has  characteristics  which 
favor  it  greatly  in  the  struggle  for  existence.  Connected  with 
the  most  complete  self-regulation  of  functionation  is  the  greatest 
saving  of  material.  While  those  parts,  according  to  their  use, 
are  strengthened  and  grow,  the  unused  degenerate  and  the  ma- 
terial for  their  substance  is  saved.  This  kind  of  process  unites 
the  greatest  economy  with  the  highest  functioning  of  the  whole, 
but  at  the  cost  of  the  independence  of  the  parts.  Senescence 
becomes  thus  a  result  in  differentiation  in  which  the  parts  exist 
merely  on  account  of  the  function  which  they  perform  for  the 
whole.  The  senescing  organs  wither  and  may  even  descend  in 
this  condition  from  generation  to  generation,  a  fact  which  often 
allows  a  fresh  start  in  development.  During  the  course  of  life- 
time the  organism  moves  from  a  more  general,  more  easily  im- 
pressible condition  to  one  more  perfectly  mechanized.  Through 
a  long  period  it  becomes,  through  the  continuous  working  of  a 
given  stimulus,  more  completely  adapted  to  itself  and  also  more 
differentiated  and  thereby  more  stable,  so  that  an  always  increas- 
ing opposition  is  formed  to  the  additional  development  of  new 
forms  and  characteristics.  The  principle,  known  as  the  law  of 
economy  of  growth,  holds  good  of  man,  as  Dohrn^  has  shown, 
not  only  as  an  organic  unit  but  as  a  compound  organism.  It  has 
been  lately  extended  to  sociolog}-  by  DeMoor.^*^ 

Degeneracy,  according  to  Ray  Lankester,^^  is  a  gradital 
change  of  structures  by  which  the  organism  becomes  adapted 
to  less  varied  and  complex  conditions  of  life.  The  opposite  pro- 
gressive process  of  elaboration  is  a  gradual  change  of  structure 
by  which  the  organism  becomes  adapted  to  more  varied  and 
complex  conditions  of  existence.  In  elaboration,  there  is  a  new 
expression  of  form  corresponding  to  new  perfection  of  work 
in  the  animal  machine.  In  degeneracy  there  is  a  suppression 
of  form  corresponding  to  the  cessation  of  work.  Elaboration 
of  some  one  organ  may  be  a  necessary  accompaniment  of  degen- 
eracy in  all  others.  This  is  very  generally  the  case.  Only 
when  the  total  result  of  the  elaboration  of  some  organs  and  the 


^  Osborn,  From  the  Greeks  to  Darwin. 
1°  Evolution  by  Atrophy. 
11  Degeneration. 


POST-NATAI,    SKUI-I.    AND    JAW    DEVELOPMENT.  37 

degeneracy  of  others  is  such  as  to  leave  the  whole  mass  in  a 
lower  condition,  that  is  fitted  to  less  complex  action  and  reaction 
in  regard  to  its  surroundings  than  is  the  type,  can  the  individual 
be  regarded  as  an  instance  of  degeneracy. 

As  Harriet  Alexander'-  has  shown,  since  degeneracy  is  a 
process  of  evolution,  leading  to  alteration  of  form  because  of 
cessation  of  inhibitions  in  certain  directions  resultant  on  dimin- 
ished work,  it  logically  follows  that  since  diminished  functioning 
precedes  change  of  structure  increased  functioning  must  check 
the  change  of  structure  in  its  biochemic  stage.  Nay,  more,  it  is 
evident  that  structural  elaboration  due  to  degeneracy  may  be 
retained  w'hile  the  degenerate  structures  resume  their  higher 
functions.  Hence  the  degenerate  race  ranks  higher  in  evolution 
because  of  the  utilization  of  the  beneficial  variations  due  to  degen- 
eracy. The  influence  of  this  principle  is  increased  by  the  fact 
that  the  majority  of  the  children  of  degenerates  inherit  a  ten- 
dency to  degeneracy  rather  than  degeneracy  itself. 

Since,  as  Kiernan^^  points  out,  certain  parts  may  disappear 
in  the  evolution  of  organs  and  certain  organs  during  the  evolu- 
tion of  organisms  and  since  the  disappearance  and  developing 
tendency  must  center  around  the  time  when  certain  functions 
will  be  lost  by  the  disappearing  and  others  gained  by  the  devel- 
oping periods  of  stress  must  occur,  around  which  the  law  of 
economy  of  growth  will  center,  the  struggle  for  existence  be- 
tween the  parts  of  organs  and  between  the  organs.  Struggles  for 
existence  on  the  part  of  the  different  organs  and  systems  of  the 
body  are  hence  most  ardent  during  the  periods  of  intra  and 
extra-uterine  evolution  and  involution.  During  the  first  denti- 
tion, during  the  second  dentition  (often  as  late  as  the  thirteenth 
year),  during  puberty  and  adolescence  (fourteen  to  twenty-five). 
during  the  climacteric  (forty  to  sixty),  when  uterine  involution 
occurs  in  woman  and  prostatic  involution  in  man,  and  finally 
during  senility  (sixty  and  upwards),  mental  or  physical  defect 
may,  as  I  have  elsewhere  shown,  occur  a  congenital  tendency  to 
w'hich  has  remained  latent  until  the  period  of  stress. 

When  systemic  balance,  the  result  of  evolution,  is  disturbed 

12  Medicine,  1896. 

13  Medicine,  1901. 


38  IRREGULARITIES    OF    THE    TEETH. 

by  change  in  environment,  the  organs,  as  has  been  shown  exper- 
imentally by  Jacques  Loeb,^"*  do  not  pursue  their  usual  growth. 
Such  disturbances  are  peculiarly  apt  to  occur  during  periods  of 
stress  because  of  the  then  varying  relations  of  dififerent  organs. 

During  the  first  extra-uterine  period  of  stress,  between  birth 
and  three  months,  the  brain  is  one-fifth  the  weight  of  the  body, 
while  in  the  adult  it  is  but  one-thirty-lhird.  During  the  first 
six  months  the  brain  doubles  in  weight.  The  efifects  of  stress 
during  this  period  would,  under  the  law  of  economy  of  growth, 
either  be  felt  in  diminution  of  the  quality  or  quantity  of  the 
brain  or  in  the  preservation  of  these  at  the  expense  of  more 
transitory  structures.  Here  the  teeth,  alveolar  process  and  jaws 
would  be  affected.  During  the  period  between  two  years  and 
six  the  same  factors  to  a  lesser  degree  are  present,  while  between 
seven  and  fourteen  the  brain  has  quadrupled  in  weight.  At 
birth  the  heart  is  small  relatively  to  the  arterial  system,  but  this 
disproportion  gradually  disappears  until  at  puberty,  when, 
according  to  Beneke,  the  relation  is  changed.  The  larger  the 
heart  relatively  to  the  vessels  the  higher  the  blood  pressure  and 
the  earlier,  stronger  and  more  complete  is  the  development  of 
puberty.  The  weight  of  the  heart  from  birth  onwards,  increases 
twelve  and  a  half  times.  During  this  period,  strain  interfering 
with  heart  growth  would  either  afifect  it  or  under  the  law  of 
economy  of  growth,  the  more  transitory  structures  for  its  benefit. 

To  a  certain  extent,  as  DeMoor^^  remarks,  periods  of  stress 
resemble  ancestral  stages.  Moreover,  when  there  is  a  recapit- 
ulation of  ancestral  stages  it  often  happens  that  evolution  takes 
place  without  leaving  traces  of  the  various  stages.  This  is 
especially  the  case  in  complex  organs  which  have  been  produced 
by  many  lines  of  evolution  converging  in  a  single  structure — a 
structure  which, thus  becomes  the  seat  of  a  special  function  or  set 
of  functions. 

The  neuron,  for  instance,  the  ganglionic  cell  of  the  cortex 
of  the  human  brain,  passes  successively  through  stages  corre- 
sponding to  those  which  are  to  be  foiuid  in  the  adult  fish,  frog, 
bird  and  mammal.     Here  development  consists  in  an  increasing 

^*  Untersuch.  zur  Physiol.   Morphologic. 
1^  Evolution  by  Atrophy. 


POST- N  AT  A  r,    SKUI.L    AND     |  A  W     I  )i:V  l.l.ol'M  I'.NT. 


39 


complexity  of  the  cell  with  no  foimatiou  of  unnecessary  rudi- 
mentary parts.  This  is  also  the  case  when  the  development  of 
the  brain  of  man  is  compared  with  the  probable  ancestral  stages 
as  displayed  in  the  vertebrate  scries. 


In    Fish    and 
Batrachia 


In   Reptiles 


In    Mamm; 


In    the    same 

mammals 
even  of  high- 
er orders   (e. 

g.,  some 
Hapalidae). 


TIk'  cerebral  hemispheres  In  the  liuman      Same 
do  ncil   cover  the  region   of       embryo     of  aspects, 

tlie    tbinl    ventricle    (Thala-  the       seventli 
menceplialon)     from     which  week. 

the  eyes  arise. 


'I'he  henn'sphercs  cover 
the  tliahimencephalon  but 
leave  uncovered  tlic  region 
of  tlie  optics  lobes  (mesen- 
cei)ha]on  ). 

The  !icniis]iheres  cover 
the  thalaniencephalon,  the 
mesencephalon,  sometimes 
the  mctcncephalon  (cerebel- 
lum and  medulla),  and  the 
olfaclorv  lobes. 


Tl 


hemispheres   are 
smooth. 


In  the  human    Same 


embryo     of 
the  middle  of 
the    third 
month. 

In  the  human 

embryo     of 

the  fifth 

month. 


aspect. 


Same 
aspect. 


In  the  human     Same 
embryo     of  asnect. 

the  middle  of 
the  fifth 
month. 


CHAPTER   V 


DEVELOPMENT  OF  THE  CRANIUM  AND  FACE. 

The  human  skull  has  a  double  origin.  There  are  really  two 
skulls  (one  inside  the  other).  These  were  originally  distinct, 
but  in  the  process  of  evolution  the  union  between  them  became 
more  and  more  intimate.  This  development  is  summed  up  in 
the  changes  which  embryologically  occur  in  man.^  The  primary 
skull,  as  I  have  elsewhere  pointed  out,^  is  practically  an  exten- 
sion of  the  vertebrae,  which  send  out  sidegrowths  to  cover  the 
brain  as  the  backbone  covers  the  spinal  cord.  The  primary 
skull  extends  in  front  of  the  notchord  (the  spinal  cord  of  the 
human  embr}-©  and  the  permanent  spinal  cord  of  the  lancelet), 
where  it  gives  ofif  two  trabeculse  cranii  (front  skull  plates).  Be- 
hind, the  primary  skull  or  chondrocranium  gives  ofif  two  occip- 
ital or  rear  skull  plates.  It  also  gives  ofif  two  plates  (midway 
between  the  trabeculae  and  occipitals),  which,  as  they  gradually 
enclose  the  primitive  hearing  apparatus  (the  otocysts,  perma- 
nent in  fish  and  embryonic  in  man),  are  called  periotic  capsules. 
This  primary  skull  is  at  first  cartilaginous,  as  in  sharks.  With 
increase  in  the  size  of  the  brain  in  evolution  and  in  human  em- 
bryolgeny  this  cartilaginous  primary  skull  becomes  insufificient 
to  roof  over  the  brain  and  thus  produces  the  gaps  called  fonta- 
nelles  (or  soft  places  at  the  top.  sides  and  back  of  the  head  of  the 
new  born  child).  These  are  the  results  of  this  failure  of  ihe 
chondrocranium  (primary  skull)  to  cover  the  gains  of  the  nerv- 
ous system  in  the  struggle  for  existence.  This  deficiency,  result- 
ant on  advance  in  evolution,  would  have  been  a  long-standing 
serious  block  to  further  advance  were  it  not  that  the  skin  of  the 
mammal  retained  a  bone-making  function  inherited  from  the 
reptiles  and  bony  fish. 

These  cavities  were  filled  with  dermal  bones  which,  at  first 
serving  merely  as  armor  in  the  skin  of  the  head,  came  ultimately 

1  Minot  Embryology,  pages  465-467. 
'  Degeneracy  Op.  Cit. 

40 


DKVEI.OPMKNT    OF    THE    CRANIUM     AND    FACE.  41 

to  be  protectors  of  the  nervous  system.  The  following  bones 
represent  these  dermal  bones  in  the  embryonic  human  skull : 
The  frontals,  whose  sutures  normally  disappear  in  the  adult  so 
that  the  forehead  seems  to  be  but  one  bone.  This  union  may  not 
occur,  when  as  in  the  case  of  the  philosopher  Kant,  the  frontal 
suture  remains  during  life.  The  sutures  arc  replaced  by  solid 
Iwnc  through  synostosis.  In  the  frontal  bone,  synostosis  is  nor- 
mal and  in  the  line  of  advance.  Elsewhere  in  the  skull  it  is  often 
an  expression  of  a  premature  senility  that  may  give  rise  to 
various  cranial  states  either  absolutely  degenerate  in  type  or 
degenerate  only  when  present  in  certain  races.  The  parietals 
and  interparietals  are  dermal  bones  so  united  l)y  synostosis  as  to 
form  the  parietals  or  side  bones  of  the  normal  adult  skull.  The 
nasal  bones,  which,  together  with  the  vomer,  form  the  nose,  are 
likewise  dermal  bones  and  so  are  the  pterygoids  and  palatines. 
The  maxillaries  and  pr?emaxillaries,  which  (with  the  mandibles) 
form  the  jaws  are  dermal  bones.  The  mandibles  are  in  part 
derived  from  the  chondrocranium. 

Owing  to  the  head  bend  of  the  embryo  the  mouth  cavity,  as 
Minot  remarks,  is  brought  between  the  forebrain  and  the  heart 
and  upon  the  ventral  surface.  The  development  of  the  face 
depends  upon  the  enlargement  and  fusion  of  the  mouth  and  nose 
cavities,  and  upon  the  later  partial  separation  of  the  nose  and 
mouth  and  nose  cavities,  leaving  the  posterior  nose  open.  It 
depends  further  upon  the  growth  and  specialization  of  the  face 
region,  of  which  elongation  is  the  most  prominent  indication, 
and  finally  upon  the  development  of  a  prominent  external  nose. 
When  the  medullary  tube  of  the  notochord  enlarges  to  form  the 
brain,  the  end  of  the  head  bends  over  to  make  room  for  that 
enlargement.  The  bending  of  the  head  carries  the  mouth  plate 
(which  is  to  be  the  mouth)  over  to  the  front  of  the  head.  Two 
changes  which  develop  the  mouth  cavity  are  the  growth  of  the 
brain  and  the  increase  in  size  of  the  heart  cavity,  which  expand 
to  the  front,  leaving  the  mouth  cavity  between  them.  The  mouth 
cavity  represents  two  gill-slitts  united  in  the  front  line.  The 
nose  is  formed  from  two  olfactory  plates  situated  just  in  front 
of  the  mouth  and  in  contact  with  the  forebrain.  These  olfactory 
plates  grow  in  size  by  the  increase  of  tissue  and  the  resulting 


42  IRREGULARITIES    OF    THE    TEETH, 

pits  pass  away  from  the  brain.  At  first  these  pits  (although 
widely  separated  by  what  is  called  the  nasal  process)  communi- 
cate freely  with  the  mouth.  The  nasal  process  includes  the 
origin  of  the  future  nose  and  of  the  future  intermaxillary  region 
of  the  upper  lip. 

The  nasal  pits  proper  are  developed  by  the  upgrowth  of  the 
ectoderm  and  mesoderm,  around  the  olfactory  plate.  The  up- 
.growth  takes  place  on  the  medial,  upper  and.  lateral  side  of  each 
plate,  and  hence  forms  two  pits  with  a  partition  (the  future  nasal 
septum)  between  them.  These  nasal  pits  communicate  along 
their  whole  lower  side  directly  with  the  mouth  cavity.  The 
nasal  pit  is  at  first  very  shallow.  In  their  growth  there  are  two 
principal  changes :  First,  growth  of  the  tissues  occurs  around 
the  olfactory  plate,  and  then  the  pits  migrate  away  from  the 
brain.  The  nasal  pits  are  separated  by  a  projecting  mass  of 
tissue  called  the  nasal  process,  which  includes  the  partition 
between  the  two  nasal  chambers,  the  outline  of  the  future  nose 
and  of  the  future  intermaxillary  region  of  the  upper  !ip.  The 
maxillary  process  extends  between  the  mouth  and  eye  toward 
the  nasal  pit  and  by  joining  the  rounded  end  of  the  nasal  process 
begins  the  separation  of  the  nasal  and  butcal  chambers  and 
completes  the  upper  border  of  the  mouth.  As  development  pro- 
ceeds, the  lateral  ridge  grows  forward  and  covers  in  the  nasal 
pit  from  the  side  forming  the  outline  of  the  wing  of  the  adult 
nose.  There  are  now  two  external  nares.  The  nasal  chambers 
enlarge  as  the  whole  face  enlarges  and  occupy  an  increasing 
space  opening  widely  into  the  mouth  cavity  above  the  palate 
shelf.  It  is  from  the  nasal  pit  proper  that  the  so-called  labyrinth 
of  the  nose  is  formed.  The  development  of  the  labyrinth  begins 
with  the  appearance  (during  the  third  month  of  embryonic  life) 
of  three  projecting  folds  on  the  lateral  wall  of  each  nasal  cham- 
ber. These  folds  are  the  upper,  middle  and  lower  turbinal  folds. 
They  very  early  contain  cartilage.  The  formation  of  labyrinth 
advances  by  formation  of  outgrowths,  which  become  the  eth- 
moidal sinuses,  by  the  appearance  during  the  sixth  month  of  the 
antrum  Highmorii  or  expansion  of  the  nasal  cavity  into  the 
region  of  the  superior  maxillary  and  finally  by  evaginations  to 
form  the  sphenoidal  and  frontal  sinuses,  which,  however,  do  not 


DEVELOPMENT    OF    THE    CRANIUM    AND    FACE.  43 

arise  in  man  until  after  birth.  \he  separation  of  the  olfactory 
plate  from  the  brain  does  not  take  place  until  the  olfactory 
ganglion  develops  from  the  epithelium.  The  fibers  lengthen, 
the  olfactory  and  neural  epithelium  separate  and  finally  the  osse- 
ous cribriform  plate  is  developed  between  them. 

'Jlie  external  nose  develops  toward  the  end  of  the  second 
month  of  embryonic  life  by  a  growth  of  the  nasal  process.  It  is 
at  first  short  and  broad,  having  (at  the  third  month  of  embryonic 
life)  very  nearly  the  shape  which  is  permanent  in  certain  negro 
races.  The  external  nares  and  wings  of  the  nose  are  carried 
forward  with  a  general  nasal  upgrowth. 

As  soon  as  the  external  nose  is  separated  from  the  mouth 
there  is  a  partition  between  the  nasal  pits  and  the  mouth.  The 
partition  in  which  the  intermaxillary  bone  is  differentiated  later, 
is  supplemented  by  another  partition,  the  true  palate,  which 
shuts  off  the  upper  part  of  the  mouth  cavity  from  the  lower,  thus 
adding  tlic  upper  part  to  the  nose  chambers.  The  palate  is  a 
secondary  structure  which  divides  the  mouth  into  an  upper  res- 
piratory passage  and  a  lower  lingual  or  digestive  classes.  The 
palate  arises  as  two  shelf-like  growths  of  the  inner  side  of  each 
maxillary  process,  and  is  completed  by  the  union  of  the  two 
shelves  in  the  median  line.  These  so  arch  as  to  descend  a  certain 
distance  into  the  pharynx.  In  the  pharynx,  however,  their 
growth  is  arrested,  though  they  may  be  still  recognized  in  the 
adult.  In  the  region  of  the  tongue,  which  includes  more  than 
the  primitive  mouth  cavity,  the  palate  shelves  continue  growing. 
At  first  they  project  obliquely  downward  toward  the  floor  of  the 
mouth  and  the  tongue  rising  between  them  seems  in  sections, 
which  pass  through  the  internal  nares,  to  be  about  to  join  the 
internasal  septum.  As  the  lower  jaw  grows,  the  floor  of  the 
mouth  is  lowered  and  the  tongue  is  thus  brought  further  away 
from  the  internasal  septum.  At  tjie  same  time  the  palate  shelves 
take  a  more  horizontal  position  and  pass  toward  one  another 
above  the  tongue  and  below  the  nasal  septum  to  meet  in  the 
middle  line,  where  they  unite.  From  their  original  jiosition  the 
shelves  necessarily  meet  in  front  toward  the  lip  first,  and  unite 
behind  toward  the  pharynx  later.  In  the  human  embryo,  union 
begins  at  eight  weeks  and  by  nine  weeks  is  completed  for  the 


44  IRREGULARITIES    OF    THE     TEETH. 

region  of  the  future  hard  palate  and  by  eleven  weeks  for  soft  also. 
The  palate  shelves  extend  back  across  the  second  and  third 
branchial  arches.  The  uvula  appears  during  the  latter  half  of  the 
third  month  as  a  projection  of  the  border  of  the  soft  palate.  Soon 
after  the  palatal  shelves  have  united  with  one  another,  the  nasal 
septum  unites  with  the  palate  also,  and  thereby  the  permanent 
or  adult  relations  of  the  cavities  are  established. 

The  fact  that  the  human  face  is  modified  backward  from 
the  vertebrate  type  excellently  illustrates  the  degeneracy  of  a 
series  of  related  structures  for  the  benefit  of  the  organism  as  a 
whole.  The  progress  of  development  of  the  vertebral  face  is 
checked  in  man  because,  as  Minot  remarks,  the  upright  position 
renders  it  unnecessary  to  bend  the  head  as  in  quadrupeds,  and 
because  the  enormous  cerebral  development  has  rendered  an 
enlargement  of  the  brain  cavity  necessary.  This  has  taken  place 
by  extending  the  cavity  over  the  nose  region  as  well  as  by 
enlarging  the  whole  skull.  Third,  because  development  of  the 
face  is  arrested  at  an  embryonic  stage.  The  production  of  a  long 
snout  is  really  an  advance  of  development,  which  does  not  occur 
in  man. 

Upon  variations  in  th-e  dermal  bones  depend  not  only  the 
race  variations  in  skull  and  jaw  types  but  also  the  variations 
produced  by  agencies  acting  on  the  individual  during  the  periods 
of  bodily  stress  and  by  the  degenerative  influences. 

Craniologists  generally  assume  two  fundamental  skull  types, 
dolichocephalous  or  long  horizontally,  that  is,  from  back  to  front, 
and  the  brachycephalous  or  approximately  round  horizontally. 
The  types  are  determined  by  the  so-called  cephalic  index,  which 
is  determined  by  the  relation  of  the  antero-posterior  diameter 
(measured  from  the  glabella  to  the  farthest  point  of  the  occiput) 
to  the  transverse  diameter  from  side  to  side.^  The  former  being 
taken  at  lOO,  the  latter  will  range  from  about  60  to  95  or  even 
more,  increasing  with  the  greater  degree  of  brachycephaly  and 
vice  versa.  Excluding  artificial  deformation,  the  extremes  appear 
to  lie  between  6i'9  (Fijian,  measured  by  Flower)  and  98.21 
fa  Mongolian,  described  by  Huxley).  This  last  approaches  the 
perfect   circle,   which   is   never  presented  by   the   normal    head, 

3  Keane  Ethnology. 


DEVELOPMENT    OF    THE    CRANIUM    AND    FACE.  45 

though  exceeded  (103-105)  by  pathologic,  teratologic  or 
deformed  specimens.  Most  peoples  are  now  mesaticephalous  and 
hence  of  mixed  descent.  This  race  intermingling  began  in 
neolithic  times.  Speaking  broadly,  the  horizontal  index  is  now 
applicable  less  to  the  primary  than  to  the  secondary  divisions  of 
mankind.  The  alleged  normal  dolichocephaly  of  African  Negroes 
has  numerous  exceptions.  The  Eskimo,  who  seemingly  ought 
to  be  brachycephalic  are  extremely  dolichocephalic. 

To  meet  the  endless  transitions  between  the  two  extremes 
Broca  proposed  the  following  five-fold  division  : 

1.  Dolichocephali     with  index  No.  75  and  under. 

2.  Sub-dolichocephali    with  index  No.  75-10  to  77.77- 

3.  Mesaticephali    with  index  No.  77-78  to  80. 

4.  Sub-brachycephali    with  index  No.  80.10  to  83.83. 

5.  Brach.vcephali  with  index  No.  83.34  upwards. 

Under  this  classification  races  may  be  ranged  thus : 

I.     DOLICHOCEPHALI. 

Kai-Colo    (mean)    65  Neanderthal    72(?) 

Australian     71-49  Hottentot  and  Bushman 72.43 

Eskimo    (Greenlander)    71-77  Kaffir    72-54 

W.   African   Negro 73-40  Low-Caste   Calcutta    74-17 

Cro-Magnon    73.34  Berber     74.63 

Nile  Nubian    1Z7^  Langerie  Basse   74-85 

Algerian    Arab    74-o6  Baumes  Chaudes    (Lozero) . .  75 

2.     SUB-DOLICHOCEPHALL 

Dolmens    N.   of   Paris 75-01  Anglo-Saxon    76.10 

Guanches    (Canaries)    75-53  Polynesians    (some)    76.30 

Old  Egyptians  75-78  Copts    (Modern  Egj-ptians) . .  76.39 

Ainus  (some)    76  Basques  of  Guipuzcoa 77.62 

Tasmanians    76. 1 1  Chinese    77.60 

3.     MESATICEPHALI. 

Ancient  Gauls  78.09      Hawaiians    80.0 

Mexicans    (normal)    78.12      Afghans    79  to  80 

Dutch     78.89       Ossetians     80.0 

Prussians    78.90       Petit    Morin     (Marne    and 

others      from      Neolithic 

caves  and   dolmens 80.0 

S.  Americans 79- 16 

N.  Americans   79-25 


46  IRREGULARITIES    OF    THE    TEETH. 

4.     SUB-BRACHYCEPHALI. 

French  Basques    80.25  Italians    (North)    81.80 

Low  Bretons  81.25  Andamanese     81.87 

Mongols   (various)    81.40  Finns    82.0 

Turks    (various)    81.49  Little    Russians    82.03 

Javanese    81.61  Germans    (South)    83.0 

5.     BRACHYCEPHALL 

Indo-Chinese    , . .  83.51  Burmese    86 

Savoyards    83.63  Armenians    86.5 

Croatians    84.83  Solutre    88.26 

Bavarians    84.87  Peruvians    93.0 

Lapps   85.07  Huxley's  Mongol   98.21 

Some  value  has  jjcen  attached  to  the  vertical  index  (high  and 
broad)  which,  when  it  rises  to  or  exceeds  100  determines  the 
so-called  hypsistenocephaly  characteristic  of  the  Maliclos  and 
other  Melanesians. 

No  cranial  measurement  is  more  important  than  that  which 
determines  the  varying  gnathism  or  greater  or  less  projection  of 
the  upper  jaw,  which  depends  upon  the  angle  made  by  the 
whole  face  with  the  brain  cap.  The  more  obtuse  the  angle  the 
greater  will  be  the  maxillary  projection  (Prognathism),  the  more 
vertical  the  face  the  less  the  projection  (Orthognathism) :  Hence 
gnathism  (best  seen  in  profile)  as  indicated  by  the  facial  angle, 
is  accepted  by  anthropologists  as  a  race  criterion.  Its  evo- 
lution (intimately  associated  with  the  dentition  and  change  from 
raw  to  cooked  food)  has  been  from  the  extreme  projection  of  the 
higher  apes  and  of  primitive  man  to  the  seemingly  vertical  posi- 
tion of  the  Mongolic  and  Caucasic  groups.  Prognathism  is, 
hence,  characteristic  of  the  lower  orthognathism  of  the  higher 
races.  The  profile  of  the  Calmuck  face  is  almost  vertical,  the 
facial  bones  being  thrown  downwards  and  under  the  forepart  of 
the  skull.  The  profile  of  the  face  of  the  negro  is  differently 
inclined  ;  the  front  part  of  the  jaws  projecting  far  forward  beyond 
the  level  of  the  fore  part  of  the  skull.  In  the  former  the  skull 
is  orthognathous  or  straight-jawed,  in  the  latter  it  is  prog- 
nathous. 

Combining  this  feature  with  eurygnathism  (that  is  lateral 
projection  of  the  cheek  bones)  Geoffrey  Saint-Hilaire  found  that 
the  Caucasic  face  is  oval  with  vertical  jaws,  the  Mongolic  broad 


DEVELOPMENT    OK    THE    CRANIUM    AND    FACE.  47 

(eurygnathous),  the  Negro  prognathous  and  the  Hottentot  both 
pro-  and  eurygnathous. 

Topinard  distinguishes  between  a  superior  and  anterior  facial 
angle.  The  former  (general  facial  gnathism)  is  fallacious  as  a 
guide.  The  latter  (that  is  sub-nasal  gnathism)  being  trust- 
worthy. Anthropologists  have  erred  in  giving  so  much  im- 
portance to  the  projection  of  the  whole  maxilla  or  of  the  whole 
face.  There  is  no  uniformity  of  results  in  any  given  series.  The 
most  flagrant  contradictions  occur  between  averages  in  allied 
races.  Sub-nasal  or  true  prognathism,  however,  furnishes  of 
itself  the  dilTerential  character  of  the  various  human  types.  Sub- 
nasal  gnathism  is  determined  by  the  angle  formed  by  a  line 
drawn  from  the  nasal  spine  (sub-nasal  point)  to  the  anterior 
extremity  of  the  alveolo-condylean  plane.  This  plane,  which 
gives  the  total  projection  of  the  skull,  is  about  parallel  with  the 
horizontal  line  of  vision  coinciding  with  a  line  drawn  from  the 
alveolar  point  (medium  point  of  the  alveofar  arch)  at  right  angles 
to  a  perpendicular  falling  from  the  occipital  condyles.  Topinard 
has  had  the  following  results : 

TRUE   OR   SUB-NASAL    PROGNATHISM. 

Individual   extreme?    891051.3       Merovingians     76-54 

White  races   821076.5       Finns   and   Esthonians 75-53 

Yellow  races    76  to  68.5      Tasmanians    75-28 

Black  races    69  to  59.5       Tahitians    75 

Gaunches    81.34  Chinese    ^2. 

Corsicans    81.28  Eskimo   71-46 

Gauls    80.87  Malays    - 69-49 

Dead  Man's   Cave 79-77  New^  Caledonians 69.87 

Parisians    78. 12  Australians     68.24 

Toulousians    78.5  W.  African  Negro 66.91 

Auvergnats     77- 18  Namaquas   and    Bushmen ....   59.58 

From  this  it  is  evident  that  absolute  orthognathism  does 
not  exist.  All  races  are  more  or  less  prognathous,  the  European 
least,  the  Negro  most,  the  Mongol  and  Polynesian  intermediate. 
In  Europe  the  most  orthognathous  were  the  Gauls,  Corsicans 
and  Neolithic  men.  The  Finns  were  the  least.  Orthognathism, 
as  the  term  is  used  in  anthropology,  simply  applies  to  the  sub- 
nasal  type  of  gnathism.  In  teratology,  the  relation  of  the  inferior 
maxilla  must  likewise  be  taken  into  consideration,  since  around 
this  turns  the  struggle  for  existence  between  the  jaws  and  teeth. 


CHAPTER  VI. 


DEVELOPAIEXT  OF  THE  JAWS. 

The  vertebrate  mouth  belongs  primitively  on  the  under  side 
of  the  head  and  is  at  first  a  simple  transversely  expanded  orifice. 
The  position  of  the  face  or  oral  region  is,  as  already  shown, 
originally  determined  by  the  head  bend.  The  embryologic  rela- 
tionships of  the  mouth  area  and  the  hypophysis  already  cited 
serve  to  explain  why  constitutional  disorders  and  infectious  dis- 
ease influence  growth  and  development  of  the  maxillae,  especially 
the  lower.  The  changes  about  the  face  so  common  and  char- 
acteristic of  acromegaly  are  extreme  illustrations  of  this. 


To  determine  the  nature  of  the  evolution  resultant  on  these 
influences  and  others  found  in  the  jaws  of  modern  races,  I  made 
numerous  measurements  (Table  I)  anent  these  changes.  The 
measurements  of  early  as  well  as  modern  peoples  were  made 
on  skulls  obtained  from  the  museums  and  crypts  of  churches 
in  Europe,  in  which  last  large  collections  of  skulfs  are  found. 

Measurements  were  made  across  the  upper  jaw  from  the 
outer  surface  of  one  first  molar  to  the  outer  surface  of  the  cor- 
responding molar  of  the  other  side  (Fig.  2).    These  points  were 

48 


DKVKiroi'.MKN  r    OF     Mil.     JAWS.  49 

taken  because  these  molars  are  first  of  the  permanent  set  to 
develop,  hence  because  developing  posterior  to  the  temporary 
ones,  they  erupt  independently  and  are  not  interfered  with  by 
any  in  the  jaw.  The  point  of  the  jaw  where  these  teeth  are 
situated  is  the  widest  normally  developed  not  influenced  by  local 
causes.  This  furthermore  was  most  accessible.  Measurements 
were  made  in  persons  over  twenty-five  years  of  age,  because  at 
or  near  this  period  growth  is  complete.  After  this  period  devel- 
opment is  very  slow.  At  thirty  to  thirty-five  years  it  ceases  alto- 
gether. 

From  analysis  of  these  measurements  of  crania  and  living 
individuals,  which  have  extended  over  years,  the  human  jaw  is 
clearly  diminishing  in  size  as  the  usual  control  experiments  were 
made  to  eliminate  error. 

Differences  in  measurements  of  the  antero-posterior  and  lat- 
eral diameter  resulted  since  in  many  cases  the  antero-posterior 
diameter  was  taken  from  the  first  and  second  molars  instead  of 
from   the   third.     y\ll    such   measurements  were   rejected. 

•  Diameter  of  the  jaw,  hence,  depends  to  a  great  extent  upon  size 
of  the  skeleton.  A  small  person  usually  has  a  small  jaw,  a  large 
person  a  large  jaw.  Exceptions,  however,  occur.  Small  people 
with  large  jaws  and  large  people  with  small  jaws  are  frequently 
observed  in  limestone  countries,  from  resultant  excessive  or 
arrested  development  of  the  maxillae.  Alarked  sexual  differ- 
ences occur.  Difference  (ranging  from  .02  to  .16  of  an  inch) 
occurs  in  living  individuals  and  in  ancient  races. 

The  lateral  diameter  of  jaws  of  existent  races  in  Europe 
is  greater  than  of  the  same  races  in  America.  The  jaws  of  Amer- 
ican Indians  are  much  larger  than  jaws  of  American  Europeans. 
The  jaws  in  older  parts  of  the  United  States  are  smaller  than 
jaws  in  the  newer.  The  differences  between  jaws  of  the  residents 
of  Boston  and  those  of  Chicago  are  thus  in  evidence. 

Alarked  differences  usually  exist  between  jaws  of  dispensary 
and  charity  patients  and  jaws  of  the  wealthier  classes. 

In  Chinese  jaws  the  range  is  only  from  2  to  2.44,  with  one 
measurement  at  2.52;  peoples  of  India,  1.94  to  2.37;  Negro,  2.07 
to  2.50;  Marshpee  Indians,  2-to  2.50.  In  Swedes  the  range  is 
from  1.88  to  2.63,  and  in  the  Danish  colony,  Dublin,  from  1.88 


50 


IRREGULARITIES    OF    THE    TEETH. 


to  2.50;  in  London,  from  1.88  to  2.44,  while  the  range  of  the 
white  people  in  America  is  from  1.75  to  2.63.  The  diminution 
of  the  jaws  is  evident  on  comparison  of  measurement  of  the  jaws 
of  the  same  peoples  at  different  periods  of  culture.  The  jaws  of 
primitive  races  are  larger  than  those  of  the  civilized. 

In  most  cases,  size  and  shape  of  the  jaws  are  commensurate 
with  the  osseous  structure  of  the  individual.  Bushmen  (small 
in  stature)  present  the  smallest  range  in  the  size  of  the  jaws — 
2.12  to  2.37  inches. 

The  range  of  ancient  races  is  2.12  to  2.62  inches,  while  that 
of  modern  is  2.12  to  2.87  inches.     Only  three  modern  races. 


Fig.  3. 

however,  have  a  minimum  of  2.12,  while  the  minimum  of  all 
ancient  races  is  2.12  inches.  The  maximum  of  ancient  races  is 
less  than  that  of  the  modern. 

The  anterior  posterior  diameter  is  from  the  alveolar  process 
at  a  point  between  the  central  incisors  extending  backward  in 
the  median  line  and  meeting  a  line  drawn  at  right  angles  to  the 
posterior  surface  of  the  third  molar  (Fig.  3). 

The  principle  holds  good  for  the  development  of  the  antero- 
posterior diameter  as  laid  down  for  the  lateral  diameter.  The 
antero-posterior  diameter  of  the  jaws  of  the  female  is  less  than 
that  of  the  male  by  from  .02  to  .24  of  an  inch.  This  disparity 
compared  with  that  of  the  lateral  diameter  is  a  natural  one.    After 


pKVKI.Ol'MKNT    OK    THK    JAWS.  51 

temporary  teeth  are  all  in  place  natural  development  of  the  jaw 
is  in  an  antero-postcrior  direction.  The  changes  in  evolution 
of  the  face  and  jaws  consist  of  shorlenins;-  of  the  antero-postcrior 
diameter.  Marked  difYcrences  arise  often  from  the  entire  arrest 
of  development  of  the  jHisterior  part  of  the  body  of  the  jaw. 
This  always  occurs  when  ])crmanent  molars  have  been  extracted, 
allowing"  the  third  molar  to  come  forward,  or  when  the  indi- 
vidual has' inherited  the  large  jaws  of  one  parent  and  the  small 
teeth  of  the  other  parent,  or  when  the  jaws  have  become  arrested 
in  development.  In  comparing  antero-posterior  diameter  of  the 
jaws  of  one  people  with  those  of  another  skull  characters  must 
be  taken  into  consideration.  In  brachycephaly  occurs  the  broad . 
jaw  and  in  dolichocephaly  the  long  jaw.  This  difference  occurs 
chiefly  in  relatively  pure  races.  It  is  evident  by  comparing 
external  condition  of  the  head  and  skull  with  the  jaws.  No 
type  of  skull  could  be  determined  from  examination  of  a  thousand 
plaster  casts  of  the  mouth  of  mixed  classes  of  people.  Local 
conditions  often  modify  the  shape  of  the  jaw  of  mixed  races. 
Correlation  between  the  shape  of  the  skull  and  jaw,  which  occurs 
in  relatively  pure  races,  does  not  -appear.  As  the  jaw  develops 
from  before  backward,  were  it  not  exercised  by  mastication  or 
were  any  permanent  teeth  extracted  or  had  the  third  molar  failed 
to  appear,  the  length  required  would  necessarily  be  much  less 
than  that  needed  by  a  jaw  full  of  teeth  or  well  exercised.  Under 
the  law  of  economy  of  growth  only  the  posterior  parts  of  the  jaw- 
actually  necessary  develop  and  thus  resulted  the  short  lower 
jaw. 

The  jaws  of  people  whose  ancestors  have  lived  in  the  United 
States  show  that  there  is  not  such  a  great  difference  in  the  width 
of  the  jaws.  Thus  in  private  patients  in  Burlington,  Vt.,  Bos- 
ton and  Chicago,  there  is  only  about  .9  in  women  and  in  men 
about  .03. 

By  comparing  these  measurements  with  those  of  the  ancient 
Britons  made  by  1\I nunnery  and  Coleman  there  is  found  a  dififer- 
6nce  of  about  .36.  The  difiference  between  ancient  Romans  is 
about  the  same.  The  difference  between  the  ancient  Britons 
and  the  English  of  to-day  is  about  .24  and  of  ancient  Romans 
and  present  Italians  of  Southern  Italy,  .31.    The  antero-posterior 


52  IRREGULARITIES    OF    THE    TEETH, 

diameter  of  the  present  size  of  the  jaws  is  about  as  low  as  the 
lowest  of  any  of  the  measurements. 

On  comparing  measurements  of  New  England  stock  with 
those  of  ancient  Britons  there  is  found  a  difference  from  .21  to 
.36,  between  ancient  Romans  and  New  England  stock  .32.  Be- 
tween the  so-called  Anglo-Saxons  and  New  England  stock,  .27. 
and  between  New  England  stock  and  present  English,  .09. 

A  much  greater  difference  w^ould  be  evident  in  the  width 
of  the  jaws  of  New  England  stock  and  the  jaws  of  early  races 
had  the  measurement  been  taken  from  the  first  or  second 
bicuspid  region  since  the  contraction  is  anterior  to  the  first 
permanent    molar. 

The  wisdom  tooth  grows  smaller  with  rise  in  evolution.  In 
the  gorilla  the  third  molar  is  in  every  respect  a  well  developed 
tooth  sometimes  even  larger  than  the  first  or  second  molar. 
Instead  of  an  imperfect  crown  it  has  a  crown  on  which  the 
cusps  are  arranged  according  to  the  typical  pattern.  The  wis- 
dom tooth  (in  primitive  races)  has  ample  space  to  range  with 
other  teeth  and  is  a  characteristic  molar.  In  higher  races  the 
lower  wisdom  tooth  exceptionally  has  the  four  cusps  distinctly 
developed.  According  to  Mummery  the  third  molar  among 
African  tribes  is  always  present  in  the  lower  jaw.  According 
to  Allen  the  third  and  fourth  molars  in  Australians  often  show 
a  tendency  to  the  bicuspid  type.  Still  more  marked  differences 
are  found  between  primitive  and  civilized  man  than  between 
the  primitive  man  and  the   mammals. 

The  alveolar  process  is  a  transitory  structure.  Bone  is  rela- 
tively permanent.  The  alveolar  process  depends  entirely  upon 
the  wedging  of  teeth  against  each  other  for  size  and  shape. 
In  primitive  races  although  the  wisdom  tooth  does  not  present 
the  variation  found  in  more  advanced  races  still  it  is  far  inferior 
to  the  teeth  of  the  anthropoid  and  lower  apes.  In  them  is 
found  the  primitive  indication  of  degeneracy  and  subsequent 
disappearance  of  this  tooth.  The  tooth  in  all  is,  however,  as 
serviceable  as  other  molars.  Among  monkeys  the  third  molar 
may  be  of  equal  size  to  the  first  and  second  or  it  may  be  larger 
or  smaller. 

These  teeth  according  to  Charles  Darwin  are  rather  larger 


DEVELOPMENT    OF    THE    JAWS.  53 

than  the  other  two  molars  in  the  orang  and  chimpanzee.  In 
macaques  (Tomes)  the  third  molar  is  larger  than  the  first  two 
and  is  quinqnicuspid  below  and  quadriciispid  above.  In  man 
as  a  rule,  the  molars  decrease  in  size  from  before  backward. 
The  first  molar  is  largest  while  in  the  anthropoid  apes  the  con- 
trary is  the  case.  There  are,  however,  notable  exceptions ;  in 
the  Australian  as  in  the  chimpanzee  the  second  and  third  molars 
are  not  smaller  than  the  first.  In  the  anthropoid  apes  the  wis- 
dom tooth  is  generally  as  large  as  other  molars,  is  not  very 
variable  and  comes  into  place  almost  simultaneously  with  the 
canine.  The  diameter  of  the  jaw  is  frequently  much  smaller 
laterally  and  antero-posteriorly  than  the  diameter  of  the  teeth 
and  alveolar  process.  In  man's  evolution  the  loss  in  number 
of  the  teeth  is  not  in  harmony  with  the  arrest  of  development 
of  the  jaw. 

In  the  evolution  of  luan  from  the  extreme  dolichocephalic 
and  brachycephalic  to  the  mesophalic  skull,  there  is  a  natural 
recession  of  the  jaws  in  the  antero-posterior  and  lateral  direc- 
tion. 

Disuse  of  the  jaw  as  a  weapon  (evident  in  the  large  canine 
of  the  male  anthropoid  apes)  exercised  an  influence  in  reducing 
the  size  of  the  jaw  and  the  teeth.  The  Neanderthaloid  jaw  is 
allied  in  type  to  that  of  the  anthropoid  apes.  The  scanty 
weapons  of  the  Neanderthal  man  indicates  that  biting  (as  among 
rowdies  to-day)  played  no  small  part  in  battle  and  particularly 
in  duels  for  female  favor.  With  development  of  weapons  this 
employment  of  the  jaw  rapidly  fell  into  disuse. 

One  of  the  chief  factors  conductive  to  arrest  of  development 
of  the  jaws  which  acts  in  a  three-fold  ratio  is  want  of  maxillary 
exercise.  This  under  the  law  of  economy  of  growth  produces 
the  following  results :  By  lack  of  exercise,  blood  which  nourishes 
the  bones  is  not  carried  to  the  part.  Blood  does  not  carry 
sufficient  material  to  the  teeth,  hence,  the  enamel  formed  is 
defective  as  a  result  early  decay  occurs.  By  lack  of  lateral 
motion  mechanical  development  of  the  alveolar  process  is  want- 
ing. The  jaw  is  steadily  growing  smaller.  Early  races  lived 
upon  coarse  food ;  roots,  herbs,  corn  and  uncooked  meats. 
Such  food  required  considerable  mastication  in  order  to  secure 


54  IRREGULARITIES    OF    THE    TEETH. 

chemical  changes  necessary  before  assimilation.  As  a  result 
of  use  the  muscles  of  the  jaw  were  dense  and  hard.  When 
contraction  took  place  they  stood  out  upon  the  sides  of  the 
head  like  large  cords.  The  bones  were  well  developed  and 
of  dense,  hard  structure.  The  processes  for  the  attachment  of 
muscles  \vere  prominent  and  large.  The  teeth  were  large  and 
deep   set   in   the   alveolar   process. 

The  upper  jaw  is  a  fixed  bone.  The  blood  supply  is  small 
owing  to  a  lack  of  stimulus  from  movement,  hence,  arrest  of 
development  is  marked.  On  the  other  hand  from  the  lower  jaw 
being  movable  more  blood  flows  to  the  part  which  thus 
becomes  increasingly  developed.  In  neurotics  and  degener- 
ates the  slightest  assistance  to  circulation  will  cause  the  lower 
jaw  to  become  excessively  developed.  Some  dentists  miscon- 
strue this  condition  and  call  the  procedure  for  its  correction 
"jumping  the  bite." 

The  teeth  upon  the  upper  jaw  are  more  subject  to  decay 
than  those  upon  the  lower  despite  the  fact  that  environment  of 
the  teeth  upon  the  lower  jaw,  especially  the  bicuspids  and  molars, 
should  render  them  most  subject  to  decay.  Teeth  are  not 
equally  subject  to  caries.  The  upper  are  more  frequently 
attacked  than  the  lower  according  to  Magitot  in  the  proportion 
of  3.2  or  according  to  Hitchcock  in  the  ratio  of  1.9;!  or  very 
nearly  two  to  one. 

Taste  has  been  so  far  cultivated  that  it  now  rcijuircs  the 
skill  of  cooks  to  produce  dishes  free  from  peculiarities  pre- 
sented in  the  early  days  of  cooking.  Thus  all  coarseness  has 
been  removed  from  food.  Cereals  are  reduced  to  the  finest 
flour  while  the  hulls  which  contain  the  phosphates  essential 
to  bone  building  and 'necessary  for  mechanical  grinding  by  the 
jaw  are  entirely  excluded- — the  growing  inclination  of  the 
race  is  to  use  food  which  requires  little  if  any  mastication.  A 
society  fad  (etiquette  in  mastication),  whereby  the  lips  are  closed 
and  the  motion  of  the  jaws  in  chewing  is  barely  perceptible  does 
not  conduce  to  strength  and  vitality,  Imt  to  atrophy  or  arrest 
of  development.  The  evolution  of  the  face  from  prognathism 
to   orthognathism   is   thus  accelerated. 

When  the  teeth  push  their  way  into  place  they  crowd  one 


DKVELOPMKN'J'    OK    THE    JAWS. 


55 


another  laterally.  By  so  doing  the  dental  arch  enlarges  and 
the  alveolar  process  develops  and  grows  about  the  teeth.  The 
lateral  movement  of  the  lower  jaw  in  the  act  of  chewing  assists 
greatly  in  producing  the  enlargement.  The  constant  movement 
of  the  lower  against  the  upper  teeth  causes  them  (in  many 
cases  or  irregularities)  to  arrange  themselves  in  their  proper 
places.  Thus  a  want  of  mastication  may  cause  arrest  of  devel- 
opment of  the  jaw  and  consequent  irregularity  of  the  teeth. 

The  jaws  and  teeth  may  exist  in  each  parent  in  perfect 
symmetry.  In  one  parent  the  jaws  and  teeth  may  be  large ;  in 
the  other  parent  small,  but  each  is  normal.  If  now  the  small 
jaw  of  one  parent  and  the  large  teeth  of  the  other  appear  in 


Fig.  4.  Pig.  5.  Fig.  0. 

the  offspring  deformity  is  sure  to  follow.  By  examining  the 
figures  of  the  dolichocephalic  (Fig.  4),  Sarmatic  brachycephalic 
(Fig.  5),  and  the  Turanic  extreme  brachycephalic  (Fig.  6)  types 
it  will  be  seen  at  a  glance  how  entirely  different  must  be  the 
single  measurement  not  only  of  the  skull  generally,  but  the  face 
and  particularly  the  superior  maxillary  bones. 

Suppose,  for  example,  that  a  person  with  one  form  of  cran- 
ium (Fig.  4)  be  married  to  one  with  another  (Fig.  6),  perfectly 
harmonious  blending  of  cranial  differences  would  scarcely  be 
possible,  even  were  both  parents  in  perfect  health  and  were 
the  offspring  to  remain  in  perfect  health  throughout  the  periods 
of  stress. 


CHAPTER    YII. 


DE\'ELOPMENT  OF  THE  ALVEOLAR  PROCESS. 

The  alveolar  processes  are  situated  tipon  the  superior  border 
of  the  inferior  maxilla  and  upon  the  inferior  border  of  the 
superior  maxilla.  These  bones  are  considered  a  part  of  the 
maxillary  bones,  and  are  so  described  by  anatomists.  They 
.'■hould,  however,  be  considered  and  described  as  practically 
separate  and  distinct  bones.  Their  structure,  embryology 
r.nd  functions  differ  completely  from  the  structure  and  func- 
tions of  the  maxillary  bones.  The  superior  and  inferior  maxillae 
are  (unlike  the  alveolar  processes)  composed  of  hard,  compact 
bone-structure.  The  large,  powerful  muscles  attached  to  them 
indicate  that  powerful  work  is  to  be  accomplished.  When  fully 
developed  they  retain  their  full  size  through  life.  The  alveolar 
processes  are  composed  of  soft  and  spongy  bone  of  a  relatively 
cancellous  structure.  As  early  as  the  eleventh  week  of  intra- 
uterine life,  calcification  of  the  deciduous  teeth  commences, 
and  by  the  twentieth  week  calcific  material  is  quite  abundantly 
deposited.  Ossification  is  also  rapidly  progressing  about  the 
dental  follicles.  At  birth  the  sacs  are  nearly  or  quite  enclosed 
in  their  soft,  bony  crypts,  and  the  crowns  of  the  teeth  upon  their 
outer  surface  are  composed  of  enamel,  which  is  dense  and  hard. 

The  embryologic  phases  of  the  dental  shelf  elsewhere  cited, 
further  illustrate  this  development. 

The  alveolar  process,  being  soft  and  spongy,  molds  itself 
about  the  sacs  containing  the  crowns  of  the  teeth  and  about 
their  roots  after  their  eruption,  regardless  of  their  position  in 
the  jaw.  While  the  alveolar  processes'  have  grown  rapidly, 
they  have,  up  to  this  time,  developed  only  sufficiently  to  cover 
and  protect  the  follicles  while  calcification  proceeds.  When 
the  crowns  have  become  calcified  and  the  roots  have  begun 
to  take  in  their  calcific  material,  absorption  of  the  borders  of 
the  processes  takes  nlace  in  the  order  of  the  eruption  of  the 
teeth.  When  the  teeth  have  erupted,  the  alveolar  process  devel- 
ops   downward,    and   iioward    wi'.h    the    leeth    until    it    attains 

56 


DKVKLOPMKNT    OF    THE    ALVEOLAR     PROCESS. 


57 


the  depth  of  the  roots  of  the  teeth,  which  extend  in  most 
instances  into  the  superior  maxillary  bone,  in  the  anterior  part 
of  the  mouth  at  least  and  the  upper  and  lower  teeth  rest  at  a 
])oint  in  harmony  with  the  rami.  The  depth  to  which  they 
penetrate  the  bone  differs  in  different  mouths.  This  depends 
upon  the  length  of  the  roots  and  the  alveolar  process.  This  in 
turn  depends  upon  the  length  of  the  rami.  The  incisive  fossa, 
the  canine  eminence  and  the  canine  fossa  give  evidence  of  this 
externally.  These  sockets  are  Hned  with  extensions  of  the  pro- 
cess, thus  making  its  upper  border  irregular.  The  fact  that  some 
of  the  teeth  are  fixed  in  the  bone  as  well  as  in  the  alveolar  process 
makes  the  correction  of  some  forms  of  irregularity  more  difficult, 
for  not  only  does  the  process  have  to  be  reshaped,  but  the  bone 
as  well.      This   is    quite   noticeable   in   correcting   irregularities 


Fig.  7. 

(jf  the  teeth  in  the  lower  maxilla.  The  crypts  of  the  permanent 
teeth  are  located  at  the  apices  of  the  roots  of  the  temporary 
teeth.  The  permanent  teeth  have  large  crowns  which  touch 
each  other,  forming  a  line  to  the  posterior  part  of  the  jaw. 
These  teeth,  as  they  erupt,  entirely  absorb  the  alveolar  process 
which  surrounded  the  temporary  teeth,  and,  as  the  new  set  come 
into  place,  a  new  process  is  built  up  about  them  for  their  sup- 
port. The  permanent  teeth  require  a  deeper  alveolar  process 
to  support  their  roots,  which  are  much  longer  than  those  of 
the  temporary  teeth.  Hence  the  difference  in  the  depth  of  the 
vaults  of  the  first  and  second  sets  of  teeth. 

The  alveolar  process  of  each  superior  maxilla  includes  the 
tuberosity,  and  extends  as  far  forward  as  the  median  line  of 
the  bone,  where  it  articulates  with  the  process  upon  the  opposite 


58  IRREGULARITIES    OF    THE    TEETH. 

side.  It  is  narrow  in  front,  and  gradually  enlarges  until  it 
reaches  the  tuberosity,  where  it  becomes  rounded. 

If  the  two  articulated  superior  maxillary  bones  be  exam- 
ined it  will  be  seen  that  the  anterior  part  is  curved,  while 
the  posterior  part  gradually  diverges  from  the  central  line 
of  ossification  of  the  maxillary  bones.  The  shape  varies  in 
different  individuals.  Some  arches  are  small  and  others  large ; 
the  arch  is  parabolic  in  some  cases  and  circular  in  others. 

The  process  is  composed  of  two  plates  of  bones,  an  outer 
and  an  inner,  which  are  united  at  intervals  by  septa  of  can- 
cellous tissue.  These  form  the  alveoli  for  the  reception  of  the 
roots  of  the  teeth.  In  some  cases  the  buccal  surfaces  of  the  roots 
of  healthy  teeth  extend  nearly  or  quite  through  the  outer  bony 
plate  and  are  covered  only  by  the  peridental  and  mucous  mem- 
branes. 

This  plate  is  continuous  with  the  facial  and  zygomatic  sur- 
faces of  the  maxillary  bone.  The  inner  plate  is  thicker  and 
stronger  than  the  outer,  and  is  fortified  by  the  palate  bones. 
The  external  plate  is  irregular  upon  the  outer  surface,  prom- 
inent over  the  roots  of  the  teeth,  and  depressed  between  the 
roots  or  interspaces. 

The  prominence  over  the  canine  teeth,  called  the  canine 
eminence,  is  very  marked,  and  decidedly  modifies  the  expres- 
sion of  the  face.  The  sockets  of  the  central  incisors  are  conical 
and  round;  those  of  the  lateral  incisors  conical  and  slightly  flat- 
tened upon  their  mesial  and  distal  surfaces,  and  not  so  large 
as  the   central    sockets. 

The  pit  for  the  cuspid  is  conical  and  much  larger  than  any 
of  the  other  sockets.  The  sockets  for  the  bicuspids  are  flat- 
tened upon  their  anterior  and  posterior  surfaces,  and  near  the 
apex  they  are  frequently  bifurcated.  The  sockets  of  the  molars 
are  large  at  the  openings,  but  at  about  the  middle  of  their 
length  they  are  divided  into  three  smaller  sockets  for  the  recep- 
tion of  the  roots.  In  the  case  of  the  third  molar  the  number  of 
sockets  ranges  from  one  large  cavity  to  three  or  four  of  smaller 
size. 

The  alveolar  process  of  the  inferior  maxilla  extends  from 
the  ramus  of  one  side  to  the  same  point  on  the  other.     The 


DEVELOPMENT  OF  THE  ALVEOLAR  PROCESS.  59 

outline  is  similar  to  that  of  tlic  superior  process,  the  anterior 
portion  being  much  thinner. 

The  description  given  of  the  structure  of  the  superior  process 
applies  also  to  the  inferior.  The  outer  plate  of  bone  opposite 
to  the  molars  and  bicuspids  is  thicker  than  the  inner  plate,  while 
the  inner  plate  opposite  the  canines  and  incisors  is  thicker  than 
the  outer. 

The  alveoli  arc  arranged  along  the  Ijurder  of  the  bone  for 
the  reception  of  the  roots  of  the  teeth.  They  correspond  in 
form  to  the  roots  which  they  acconnuodate.  The  alveoli  fOr 
the  central  incisors  are  smaller  than  those  for  the  lateral.  They 
are  conical  in  shape,  and  flattened  upon  their  mesial  and  distal 
surfaces.  Those  for  the  lateral  incisors  are  larger,  and  com- 
pressed on  their  mesial  and  distal  surfaces.  The  sockets,  for 
the  canines,  cuspids,  or  stomach  teeth,  are  larger,  deeper  and 
less  compressed  than  those  for  the  incisors. 

The  sockets  of  the  bicuspids  are  considerably  flattened 
upon  their  lateral  surfaces,  and  are  sometimes  divided  into  two 
cavities.  The  sockets  for  the  anterior  roots  of  the  molars  are 
broad  and  flattened  laterally,  while  those  for  the  posterior  roots 
are  round.  The  third  molar,  being  naturally  of  variable  form, 
has  sometimes  one  pit,  and  again  three  or  four.  Each  alveolar 
pit  or  socket  is  divided  from  its  neighbor  by  a  small  wall  or 
septum,  which  is  made  up  of  cancellated  bone,  extending  about 
one-eighth  of  an  inch  above  the  inner  and  outer  plate. 

The  dental  septa  assist  in  keeping  the  teeth  firmly  in  their 
places.  The  septa  are  very  thin  at  the  margin,  and  gradually 
increase  in  width  to  the  middle  of  the  jaw.  where  they  become 
thicker,  and  are  finally  lost  in  the  substance  of  the  jaw.  Some 
septa  are  thicker  than  others,  and  where  two  teeth  'are  widely 
separated,  the  width  of  the  repta  naturally  corresponds  to  the 
space  between  the  teeth. 

In  the  evolution  of  the  jaws  with  arrest  of  development, 
there  is.  in  most  cases,  a  high  vault.  This  new  condition  tends 
to  lengthen  the  alveolar  process.  It  becomes  much  thinner. 
What  is  true  of  the  change  in  the  size  of  the  jaws  and  the  alveolar 
process  is  also  true  in  respect  to  the  shape  of  the  crowns  of 
the  teeth,    \\'hile  they  are  not  growing  smaller  in  proportion  to 


60 


IRREGULARITIES    OF    THE    TEETH. 


the  size  of  the  jaws,  they  are  changing  shapes.  Once  they 
were  relatively  bell  shaped,  giving  considerable  space  between 
the  roots  for  a  thick  alveolar  process,  thus  rendering  support 
to  the  peridental  and  mucous  membranes,  now  the  shape  has 
changed.  The  proximal  surfaces  are  almost  straight,  lessen- 
ing the  width  and  thus  allowing  only  for  a  thin  septum,  with 
barely  sufficient  surface  to  support  the  tissues. 

The  sockets  are  lined  with  a  thin  plate  of  compact  bony 
substance,  extending  from  the  outer  and  inner  plate  of  the 
alveolar  process  to  the  apex,  where  there  are  small  openings 
for  the  entrance  of  nerve  and  blood-vessels  for  the  nourish- 
ment of  the  teeth. 


k4- 


J 


Fig.  8. 

This  bony  plate  has  upon  its  inner  surface  the  elastic  peri- 
dental membrane,  which  acts  as  a  cushion  for  the  teeth,  while 
upon  the  inner  surface  it  is  surrounded  by  spongy  bone. 

The  teeth  are  held  firm  in  their  alveolar  sockets  by  a  union 
called  gomphosis,  which  resembles  the  attachment  of  a  nail  in 
a  board.  Teeth  with  one  conical  root,  and  those  with  two  or 
more  perpendicular  roots,  are  retained  in  position  by  an  exact 
adaptation  of  the  tissues.  Teeth  having  more  than  one  root, 
and  those  bent  or  irregular,  receive  support  from  all  sides  by 
reason  of  their  irregularity.  The  teeth  are  also  held  in  position 
by  the  peridental  mernbranes.    In  Fig.  8  is  seen  the  position  of 


DEVF.LOPMENT    OF    THE    ALVEOLAR    PROCESS. 


()1 


ihc  teeth  in  the  jaws,  'ihe  peridental  nienihrane  which  hnes 
the  alveohLs  and  eovers  the  roots  of  the  teetli  is  a  fibrous  tissue, 
that  achnits  of  shs^ht  nu)tion  of  the  teeth,  and  acts  as  a  cushion 
to  protect  the  jaws  from  sexere  l)h)\vs  and  concussions  while 
tearing'  and   j^rindint;-   iood. 

After  renunal  of  the  permanent  teeth  the  alveolar  process 
is  entirely  ahsorl)ed.  In  l'"i^'.  t)  is  shown  lu)w  absorption  takes 
place.  The  teeth  have  all  been  removed  from  the  superior 
maxilla,  as  has  also  the  alveolar  process.  The  molars  on  the 
lower  jaw  have  ben  extracted,  and  absorption  of  the  alveolar 
process  has  resulted,  showing  a  marked  contrast  in  conection 
with    the    anterior   alveolar   process,   which   remains   intact   and 


Fig-,  i). 

holds  the  teeth  firmly  in  place.  It  is  evident,  from  the  changes 
which  occur  from  the  first  development  of  the  teeth  to  their 
final  extraction,  that  the  alveolar  process  is  solely  for  the  pur- 
pose of  protecting  the  teeth  in  their  crypts  during  development 
and  after  eruption.  When  the  temporary  teeth  are  in  place  the 
alveolar  process  remains  unchanged  (except  a  gradual  enlarge- 
ment in  harmony  with  the  growth  of  the  maxillary  bones) 
until  about  the  sixth  year,  wdien  the  second  set  of  teeth  appears. 
The  crowns  of  the  permanent  teeth  require  more  space  than 
those  of  the  temporary  set ;  and  the  alveolar  process  must 
necessarily  enlarge  to  accommodate  them.  This  enlargement 
of  the  alveolar  process  is  caused  by  the  formation  of  the  crowns 


G2 


-Ari 


'h. 


irregulAritpes  of  the  teeth. 


of  the  permanent  teeth  before  eruption,  and  to  a  Hmited  extent 
by  the  growth  of  the  maxillary  bones,  which  may  cease  develop- 
ing at  any  period  of  life,  or  continue  to  develop  as  late  as  the 
thirty-sixth  year.  The  diameter  of  the  crowns  of  the  permanent 
teeth  forming  a  larger  circle  than  that  of  the  maxillary  bones, 
the  alveolar  process  must  necessarily  increase  its  diameter.  It 
is  often  forced  outside'  of  the  superior  maxilla  by  the  crowns 
of  the  permanent  teeth  crowding  and  wedging  themselves  into 
positions  anterior  to  the  first  permanent  molar  teeth.  This 
enlargement  of  the  alveolar  process  usually  takes  place  anterior 
to  the  first  permanent  molars.  The  process  corresponds  in  size 
to  the  jaws.    In  Fig.  lo  shows  a  superior  maxilla,  comparatively 


Fig.  10. 

small  in  proportion  to  the  inferior.  This  is  the  result  of  arrested 
development,  the  arrest  including  the  bones  of  the  face.  To 
allow  for  the  defficiency  in  bone-structure,  and  to  allow  the 
upper  teeth  to  extend  over  the  lower,  the  upper  teeth  have 
forced  the  alveolar  process  forward.  The  space  shows  where 
a  tooth  was  extracted  after  all  the  teeth  were  in  position.  The 
teeth  of  to-day  have  not  varied  in  size  in  proportion  to  the  jaws. 
To  compensate  for  this  difference,  the  alveolar  process  has  to 
expand,  or  enlarge,  to  allow  the  teeth  to  come  in  evenly.  If 
the  teeth  antagonize  uniformly  the  arch  will  enlarge  around 
evenly.    If  the  molars  are  fixed  the  alveolar  process  will  expand 


DKVKLOl'MKNT    OK    THK    ALVKOl.AR    PROCESS. 


63 


anteriorly.  If  the  teeth  shouhl  not  aniaj^onize  evenly,  a  break 
will  take  plaee  at  that  point,  pnxincin^-  a  \'  or  saddle  arch. 

In  Fig.  9  all  the  npper  teeth  have  been  removed  and  absorp- 
tion has  entirely  obliterated  the  alveolar  process.  The  relations 
of  the  superior  maxillary  bones  to  the  alveolar  process  and 
teeth  on  the  lower  jaw  are  well  illustrated.  When  the  alveolar 
process  and  teeth  were  intact  they  presented  an  appearance 
seen  in  Fig.  lO. 

The  position  and  shape  of  the  processes  and  their  relation 
to  each  other  are  governed  entirely  by  the  location  and  size 
of  the  teeth  and  roots,  and  not  by  the  shape  of  the  jaw-bone 
proper.  The  dental  follicles  containing  the  crowns  may  be 
located  upon  the  outer  border  of  the  jaw-bone  on  one  side,  in 


Fig.  n. 

which  case  the  alveolar  process  will  be  situated  upon  the  outer 
border,  and  assume  an  irregular  arch.  If  the  crowns  of  the 
teeth  are  located  upon  the  inner  border,  or  if  one  jaw  be  smaller 
than  the  other,  the  teeth  \\ill  articulate  and  the  process  will 
form  a  smaller  circle  than  the  jaw-bone  proper.  Such  a  case 
is  illustrated  in  Fig.  1 1 .  The  superior  maxilla  is  much  larger 
than  the  inferior,  and,  as  a  result,  the  articulation  of  the  teeth 
and  the  muscles  of  the  cheeks  and  lips  have  carried  the  teeth 
and  alveolar  process  on  the  upper  jaw  inward.  The  teeth  on 
the  lower  jaw  are  regular  and  appear  to  have  sufficient  room, 
while  those  upon  the  upper  jaw  are  crowded  and  overlap  each 
other.     The  teeth  on  the  left  side  of  the  upper  jaw  are  more 


64 


IRREGULARITIES    OF    THE    TEETH. 


regular  than  those  on  the  right  side.  Upon  examining  the 
mouth,  or  model,  the  arch  on  the  left  side  will  be  found  full 
and  regular,  while  the  arch  upon  the  right  side  has  a  perfect 
semi-V-shape. 

The  alveolar  prQcess  on  the  right  side  extends  consider- 
ably over  the  border  of  the  maxillary  bone,  and  the  teeth 
(especially  the  cuspid)  have  taken  quite  an  incline  in  order  to 
articulate  with  the  teeth  upon  the  lower  jaw,  thus  crowding  the 
alveolar  process  to  the  inner  border  of  the  maxillary  bones. 

The  process  is  solely  for  retaining  the  teeth,  and  if  for  any 
reason  the  dental  folHcles  should  not  be  present  and  the  tooth 
should  not  erupt,  or  if  it  should  have  been  extracted  early,  the 
process  would  not  be  developed  at  that  point.  In  my  collection 
of  models  may  be   seen  cases  of  arrested  development  of  the 


Fig.  12. 

alveolar  process,  caused  by  the  lack  of  bicuspid  and  lateral 
incisor  germs,  and  by  the  extraction  of  the  deciduous  and  per- 
manent teeth. 

If  one  or  more  teeth  should  not  antagonize,  the  alveolar 
process  would  extend  beyond  the  natural  border,  carrying  the 
teeth  with  it.  A  marked  illustration  of  this  is  seen  where  the 
molars  are  decayed  to  the  gum  and  the  roots  remain.  The  vas- 
cularity of  the  process  is  such  that  its  development  results. 
Excessive  development  of  the  alveolar  process  is  frequently 
observed  by  every  practitioner  in  connection  with  the  anterior 
inferior  teeth.  \\'hen  the  articulation  is  normal,  occlusion  of 
these   teeth  never  takes   place.      It   is   frequently   found   (espe- 


DKVKLOl'MKNT    OK    THK,    ALVKOLAK     I'KOCKSS.  05 

cially  in  patients  from  six  to  twelve  years  of  age)  that  these 
teeth  extend  to  and  occhide  with  the  mucous  membrane  of  the 
hard  palate,  making  one  of  the  most  difficult  forms  of  irregu- 
larities to  correct.  Such  a  case  is  illustrated  in  Fig.  12.  This 
model  is  taken  from  the  jaw  of  a  person  thirty-seven  years  of 
age,  but  this  excessive  development  [)r(j1)ably  took  place  between 
the  ages  of  six  and  twelve,  because  at  that  period  the  vascularity 
of  the  tissues  is  more  vigorous  and  the  development  of  the 
process  more  formative  than  at  any  period  subsequent  to  the 
development  of  the  first  permanent  teeth. 

In  a  case  in  which  the  incisors  and  cuspids,  together  with 
their  alveolar  process,  were  situated  upon  the  external  surface, 
while  the  bicuspids,  molars  and  their  alveolar  process  are 
located  upon  the  inner  border  of  the  jaw.  In  another  case  the 
alveolar  process  failed  to  cover  the  roots  of  the  bicuspids  and 
molars  upon  the  outer  surface,  the  teeth  having  forced  them- 
selves into  a  larger  circle  through  the  alveolar  process  by  the 
contact  of  the  crowns.  The  roots  in  this  case  can  be  easily 
outlined  by  the  finger  through  the  mucous  membrane ;  the 
outer  plate  of  the  alveolar  process  barely,  if  at  all,  covering 
them.  Tomes  illustrates  a  case  of  faulty  development  of  the 
outer  plate  of  the  alveolar  process  exposing  the  crowns  of  all 
the  temporary  teeth.  The  case  was  a  child  who  had  suffered 
from  hydrocephalus.  I  have  a  number  of  models  showing  the 
anterior  alveolar  process  projecting  beyond  the  normal  position 
by  the  forward  movement  of  the  molars.  This  may  be  due  to  a 
natural  movement  of  the  molars  forward,  or  the  process  may 
be  forced  forward  by  the  improper  occlusion  of  the  jaws.  The 
teeth  are  moved  from  one  position  to  another  simply  by  the 
force  consequent  upon  absorption  and  deposition  of  bone.  This 
is  noticeable  in  the  spaces  between  the  centrals,  when  the 
alveolar  process  develops  to  a  larger  circle  than  is  necessary  to 
accommodate  the  teeth.  The  alveolar  processes  are  influenced 
in  one  direction  or  the  other  by  the  pressure  of  articulation. 
This  abnormal  condition  is  the  result  of  inharmonious  develop- 
ment of  the  jaws.  The  teeth  may  come  together  in  such  a 
manner  as  to  throw  the  alveolar  processes  either  to  the  right 
or  left,  thus  producing  a  full  round  arch  upon  one  side  of  the 


66  IRREGULARITIES    OF    THE    TEETH. 

jaws  and  a  perfectly  flat  or  straight  arch  upon  the  other.  (Fig. 
ii).  The  greatest  deformity  is  that  in  which  the  teeth  of  the 
upper  jaw  and  alveolar  process  are  forced  forward,  causing  a 
protrusion  of  the  anterior  superior  part  of  the  mouth.  Occa- 
sionally both  upper  and  lower  alveolar  processes  are  carried 
forward  in  the  same  manner.  The  alveolar  process  upon  the 
lower  jaw  is  more  liable  to  be  found  upon  the  inner  border  of 
the  jaw  than  is  the  upper  alveolar  process,  as  the  inferior  max- 
illa is  larger  and  more  dense  than  the  superior,  and  when  the 
teeth  are  once  in  position  upon  the  lower  jaw  they  are  not  liable 
to  subsequent  change.  As  the  jaws  become  smaller  and  more 
delicate,  the  anterior  alveolar  process  becomes  thinner  and  less 
liable  to  resist  the  forward  movement  of  the  molar  and  cuspid 
teeth,  thus  producing  anterior  protrusion  and  V-shaped  irregu- 
larities. Owing  to  this  fact  the  teeth  of  the  superior  maxilla  do 
not  form  so  great  a  circle,  causing  the  teeth  upon  the  sides  of 
the  jaws  to  conflict  and  the  lower  teeth  and  alveolar  processes 
to  be  carried  in,  while  the  anterior  teeth  of  the  lower  jaw  are 
held  inside  of  the  superior  anterior  teeth,  thus  carrying  the 
alveolar  process  inward. 

The  teeth  are  continually  changing  their  positions  in  the 
mouth.  This  is  as  often  beneficial  as  it  is  detrimental.  That 
the  teeth  may  perform  their  full  function,  they  should  not 
only  remain  firmly  fixed  in  the  alveolar  process,  but  should  also 
antagonize.  The  teeth  may  be  compared  to  the  bricks  in  an 
arch ;  remove  a  brick  and  the  arch  falls  to  pieces.  It  is  fre- 
quently found  that  the  teeth  do  not  articulate  properly,  and  by 
cutting  away  the  approximal  surfaces  a  better  articulation  may 
be  secured.  When  this  operation  is  performed  the  teeth  move 
in  their  sockets  by  absorption  and  deposition  of  bone,  demon- 
strating the  fact  that  the  process  changes  in  shape  and  substance. 

The  tendency  of  the  alveolar  process  to  develop  between 
the  sixth  and  twelfth  year  (two  periods  of  stress)  is  something 
marvelous.    This  seems  to  be  its  period  of  greatest  activity. 

Physiologic  development,  however,  is  governed  entirely  by 
the  eruption  of  the  teeth.  The  air  passages  may  become  filled 
by    excessively    developed    bones    or    mucous    membrane,    by 


DEVELOPMKNT    OK    THF,    ALVKOLAR    I'ROCF.SS.  67 

adenoid  vegetation  or  other  causes ;  as  a  result  mouth-breath- 
ing will   take  place. 

The  lower  jaw  drops,  and  the  pressure  is  taken  away  from 
the  teeth. 

In  idiocy,  and  imbecility,  and  other  degenerate  conditions, 
mouth-breathing  is  very  common.  In  these  cases  a  long,  thin 
alveolar  process  occurs.  The  teeth  continue  to  erupt,  and  the 
alveolar  process  elongates.  Occasionally  when  the  mouth  is 
closed  the  six  anterior  teeth  will  elongate,  and  the  lower  incisor 
will  penetrate  the  superior  alveolar  process.  In  such  cases  the 
superior  incisors  protrude  and  separate.  This  deformity  will 
continue  until  the  upper  incisors  cease  to  develop,  owing  to 
the  pressure  of  the  alveolar  process  upon  the  lower  incisor 
teeth. 

The  first  thing  to  do  to  correct  this  deformity  is  to  place  a 
plate  in  the  mouth,  to  allow  the  lower  incisors  to  rest  upon  the 
plate. 

In  this  manner  the  pressure  is  taken  from  the  bicuspids 
and  molars.  In  two  or  three  months'  time  the  posterior  teeth 
and  alveolar  process  will  elongate  from  .12  to  .16  of  an  inch; 
thus  showing  the  possibility  of  the  development  of  the  alveolar 
process  in  a  short  time  by  removing  the  pressure. 

In  some  cases  excessive  development  of  the  alveolar  process 
goes  on  very  rapidly,   especially  in   epileptics. 

This,  however,  takes  place  at  the  time  of  the  development 
of  the  first  teeth. 

From  what  has  already  been  said  of  the  vascularity  of  the 
alveolar  process,  it  is  evident  that  hypertrophy  of  the  tissue 
ensues  from  simple  irritation  of  varying  degree.  The  irritation 
consequent  upon  the  eruption  of  the  teeth,  together  with  the 
excessive  blood-supply  are  both  primal  cases  of  over-building 
of  tissue,  i.  e.,  hyperplasia. 

The  ragged  roots  of  the  temporary  teeth,  produced  by 
absorption,  the  gases  from  the  putrescent  pulps,  and  the  pressure 
of  the  permanent  crowns  against  the  tissues,  produce  sufficient 
stimulation  to  excite  physiologic  action.  Tissue-building  gen- 
erally is  seen  in  connection  with  the  teeth  posterior  to  the  cuspid, 
rather  than  with  the  teeth  anterior  to  that  tooth.     It  seems 


68 


IRREGULARITIES    OF    THE    TEETH. 


accountable  only  from  the  fact  that  the  incisors  have  sharp 
cutting-edges,  the  roots  of  the  teeth  are  single  and  nearly  always 
shed  before  the  permanent  teeth  are  in  place,  and  they  erupt 
at  an  age  when  there  is  less  vitality.  Per  contra,  the  crowns  of 
the  teeth  posterior  to  the  cuspid  are  broad,  the  roots  of  the 
temporary  teeth  posterior  to  the  cuspids  are  more  numerous 
than  those  anterior  to  them,  and,  with  the  exception  of  the 
first  permanent  molars,  they  erupt  at  the  age  of  greatest  vitality. 
Epileptics  most  often  possess  these  stigmata.  Excessive  devel- 
opment of  the  alveolar  process  is  unusually  common  among 
them,  as  is  also  the  case  with  the  muscles  of  the  body.     The 


Fig.  13. 

process  becomes  unnaturally  thick,  the  bicuspids  and  molars 
are  carried  in  one  direction  and  another,  effecting  a  variety  of 
irregularities.  I  have  frequently  observed  hypertrophy  in  con- 
nection with  epilepsy.  This  is  due  to  unstable  tissue-building, 
often  found  among  degenerates.  A  common  form  is  shown 
in  Fig.  13.  Similar  irregularities  are  also  seen  in  Cole's  "Deform- 
ities of  the  Mouth,"  Figs.  12,  13,  and  27;  and  in  Tomes'  "Dental 
Surgery,"  Fig.  90.  These  deformities  all  take  the  contour  of 
the  saddle-shaped  arch.  This  may  be  accounted  for  from  the 
fact  that  the  permanent  molars,  being  the  first  teeth  to  erupt, 
become  fixed  before  the  deposit  commences.  The  crowns  of 
the  bicuspids  are  also  held  in  a  small  circle  by  the  retention 


DEVELOPMENT  OF  THE  ALVEOLAR  PROCESS. 


69 


of  the  temporary  molars.     When  these  teeth  do  not  antagonize 
they  are  Hahle  to  be  carried  inward. 

Tlie  cuspids,  witli  tlicir  long  roots,  meet  resistance  either 
in  connection  with  the  teeth  adjoining  or  with  those  upon  the 
opposite  jaw.  and  are  thus  held  in  position.  It  will  be  observed 
that,  in  all  these  cases,  the  enlargement  seems  to  be  associated 
with  the  inner  plate  of  the  alveolar  process.  In  most  of  these 
cases  the  imicr  plate  is  the  part  of  the  alveolar  process  affected. 
The  outer  plate,  although  quite  irregular  from  the  arrangement 
of  the  teeth,  is  usually  normal  in  thickness.     This  disparity  in 


Fig.  14. 

the  two  plates  of  the  aveolar  process  may  be  accounted  for  from 
the  fact  that  the  inner  plate  of  the  alveolar  process  possesses 
a  large  blood-supply — the  posterior  or  descending  palatine 
arteries  furnishing  the  ossific  material.  I  have  observed  cases 
where  the  hypertrophy  has  extended  to  and  included  the  outer 
plate.  When  the  outer  plate  becomes  involved  the  alveolar 
process  assumes  a  very  thick  condition.  Occasionally,  hyper- 
trophy will  affect  one  side  only  or  one  distinct  locality.  In 
Fig.  14  is  seen  such  a  case.  In  this  case  the  enlargement  is 
upon  the  left  side  and  extends  from  the  first  bicuspid  posterior 
to,  and  including,  the  maxillary  tuberosity.    Instead  of  the  force 


70  IRREGULARITIES   OF    THE    TEETH. 

being  directed  inward,  as  is  generally  the  case,  the  process  is 
forced  outward  and  backward.  This  enlargement  occurred  pre- 
vious to  the  development  of  the  second  and  third  molars.  The 
alveolar  process  extends  downward  and  occludes  with  the  teeth 
upon  the  lower  jaw,  thus  preventing  the  molars  from  erupting. 

Under  the  microscope,  two  systems  of  Haversian  canals  are 
seen  in  the  alveolar  process. 

These  Haversian  canals,  according  to  Kolliker,^  are  of  two 
kinds.  One  with  the  regular  lamellae  system  surrounding  it, 
and  the  other,  the  so-called  Volkmann's  canals,  containing  the 


Fig.  15. 
Section  of  Bone  showing  Blood  Vessels  of  V.  Ebner. 

perforating  vessels  from  Von  Ebner,  which  have  no  surrounding 
lamellae,  but  simply  penetrate  through  the  layers  of  bone.  Volk- 
mann's canals  are  present  in  all  tubular  bones  in  old  and  young. 
While  especially  present  in  the  outer  basal  lamellae,  they  occur 
also  in  the  interstitial  leaflets  and  in  the  inner  chief  lamellae 
as  well  as  in  the  periosteal  layers  of  the  skull  bone.  Here  their 
number  is  very  variable  (Fig.  15).  They  run  partly  transversely 
or  obliquely,  and  also  partly  longitudinally  through  the  lamel- 
lae.   Many  of  these  canals  open  in  the  outer  or  inner  surfaces  of 

1  Handbuch  der  Gewebelehre,  page  272. 


DEVELOPMENT  OF  THE  ALVEOLAR  TROCESS. 


71 


the  substantia  (compact  substance),  and  also  here  and  there  in 
the  Haversian  canals,  and  form  altogether  usually  a  wide-meshed 
irregular  net-work.  In  their  structure  they  are  sometimes 
smooth  and  sometimes  furnished  witii  dilatations  and  angles 
projecting  in  and  out  in  profile.  The  widest  has  a  diameter 
of  lOO  micrometers  or  more,  and  the  narrowest  not  more  than 
lo  or  20  micrometers,  and  there  are  still  narrower  ones  which 
are    altogether    obliterated,    appearing    like    rings    or    circular- 


Fig.  16. 

Section  of  Bone  (higher  magnification) 

showing  Blood  Vessels  of  V.  Ebner. 

formed  structures  without  any  lumen,  or  like  those  far  from 
rare  obliterated  true  Haversian  canals  first  described  by  Tomes 
and  de  jMorgan.  The  contents  of  the  A'olkmann  canals  are  the 
same  as  the  Haversian  canals. 

Fig.  15  is  a  cross  section  of  the  medulla  of  a  calcified  human 
humerus  slightly  enlarged.  The  outer  lamellge  contains  a  large 
number  of  \'olkmann"s  canals  running  longitudinally  and  trans- 
versely and  extending  through  the  outer  plate  of  bone  into  the 
periosteum.     Fig.   16  the  cross  section  of  the  section  seen  in 


72 


IRREGULARITIES    OF    THE    TEETH. 


Fig.  15  shows  these  canals  more  highly  magnified.  The  Haver- 
sian canals  are  large  round  spaces  (Fig.  17),  containing  a  single 
artery  and  vein.  The  fine  hair-like  spaces  running  from  these 
large  spaces  are  canaliculi.  The  dark  spots  encircling  each 
Haversian  canal  are  the  lacunas.     The  canaliculi  run  from  one 


Fig.  ir. 

Transverse  section  of  the  Diaphysis  of  the  Humerus 

magnified  350  times,    a,  Haversian  canal.     Dark 

spaces  Lacunae.    Hair-like  spaces 

Canaliculi. 


lacunae  to  another  or  into  a  Haversian  canal,  or  they  anastomose 
with  each  other.  The  lacunae  seem  to  be  about  uniformly  dis- 
tributed throughout  the  bone.  The  spaces  between  the  lacunae 
and  canaliculi  are  filled  with  lime  salts. 


DEVELOPMENT  OF  THE  ALVEOLAR  PROCESS.  73 

A  longitudinal  section  of  bone  (Fipc.  i8)  is  similar  in  appear- 
ance to  the  cross  section.  Instead  of  the  lacuna:  being  arranged 
in  rows  around  the  Haversian  canals  they  are  parallel.  It  will 
be  noticed  that  the  Haversian  canals  run  in  different  directions 

«"  *  £        1,        ^       f 


'%^m 


Fig.  18. 

Longitudinal  section  of  Bone  magnified  100  times, 
a,  Haversian  canals.    6,  Lacunse  seen  from 
the  side,     c,  Canaliculi. 

and  communicate  with  each  other  at  certain  intervals.  The 
foregoing  covers  essentially  the  minute  anatomy  of  the  alveolar 
process. 


CHAPTER  VIII. 


develop:ment  of  the  vault. 

The  roof  of  the  mouth  has  received  several  names  as  the 
arch,  another  the  dome,  still  a  third  the  palate.  The  word  arch, 
although  used  in  its  proper  place,  is  often  likely  to  be  so  con- 
founded with  the  dental  arch  as  to  create  confusion.  Thus  V 
or  saddle-shaped  arch  is  spoken  of,  but  the  reader  is  quite 
unable  to  decide  whether  the  writer  intended  to  refer  to  the 
dental  arch  or  the  roof  of  the  mouth.  In  former  papers  I  have 
used  the  term  vault  in  distinction  from  the  dental  arch,  and 
shall  therefore  continue  its  use  in  the  present  volume. 

The  vault  of  the  mouth  is  made  up  of  the  hard  palate,  the 
soft  palate,  and  the  alveolar  process.  The  hard  palate  consists 
of  two  horizontal  plates  of  bone  extending  from  the  superior 
maxillary  bone  upon  either  side  and  uniting  at  the  median  line, 
and  from  the  anterior  alveolar  process  in  front,  it  extends  back 
on  an  average  of  two  inches,  when  it  unites  with  the  soft  palate. 
The  hard  palate  is  composed  of  six  distinct  parts ;  two  incisive 
bones,  two  palate  plates  of  the  superior  maxillae,  and  two  hori- 
zontal plates  of  the  palate  bones.  The  incisive  bones,  however, 
become  so  firmly  united  to  the  maxillary  plate  of  bone  so  early 
in  life  that  the  suture  becomes  obliterated.  The  period  of  ossi- 
fication of  the  median  suture  varies  in  different  individuals,  some- 
times as  early  as  the  third  and  fourth  years,  and  again  as  late 
as  the  fifteenth  and  sixteenth  year. 

Widening  the  arch  by  means  of  a  jack  screw,  has  opened 
the  suture  of  the  median  line  in  fourteen  children  from  twelve 
to  sixteen  years  of  age.  This  was  accomplished  by  very  little 
pressure,  showing  that  union  had  not  taken  place.  These  were 
all  neurotics. 

As  a  whole,  the  hard  palate  may  be  described  as  a  horizontal 
partition,  or  floor,  separating  the  nasal  cavity  from  the  mouth. 
The  anterior  part  of  the  palate  bone  unites  with  and  becomes 
a  part  of  the  alveolar  process.     The  upper  surface  of  the  hard 

74 


DEVELOPMENT    OF    THE    VAULT.  75 

palate  joins  the  floor  of  the  nasal  passages,  which  are  divided  in 
the  center  by  the  union  of  the  vomer.  This  bone,  which  is 
quite  thin  at  its  middle  portion  and  cartilaginous  at  the  anterior 
part,  begins  to  thicken  as  it  reaches  the  floor  of  the  nose,  at 
which  place  it  gradually  produces  a  smooth  appearance,  divid- 
ing the  nostril  into  two  rounded  arches. 

Upon  the  palatal  surface  it  is  very  uneven.  Along  the 
median  line  is  frequently  found  a  rough  ridge  of  bone,  resem- 
bling a  section  of  rope,  running  its  entire  length,  about  the 
size  of  a  slate  pencil.  Such  a  condition  is  frequently  observed 
in  Peruvian  skulls.  Out  of  228  examined  at  the  Peabody 
Museum,  Harvard  College,  sixteen  had  this  peculiar  appearance. 
In  more  modern  skulls  are  often  present  knots,  or  rough  lumps 
of  bone,  at  intervals  along  the  suture.  Again,  a  thick  band  of 
bone  from  .25  to  .50  of  an  inch  in  width,  extending  part  way  or 
the  entire  length  of  the  suture,  occurs.  This  thickness,  or 
prominence,  commences  at  the  alveolar  border  and  becomes  the 
widest  at  the  second  bicuspid  and  first  permanent  molar,  where 
it  gradually  narrows  to  a  mere  point  at  a  line  drawn  across  the 
vault  at  the  posterior  surface  of  the  second  molar. 

The  hard  palate  varies  in  thickness  in  different  localities 
and  differs  in  thickness  in  different  individuals.  Around  the 
edge  where  it  unites  with  the  maxillary  bone  and  alveolar  pro- 
cess it  is  quite  thick,  and  also  at  the  median  line ;  while  about 
midway  between  these  two  parts  the  bone  is  as  thin  as  tissue 
paper.  I  have  also  observed  it  from  .12  to  .18  of  an  inch  in 
thickness.  At  the  median  line,  and  just  back  of  the  incisors, 
is  a  fossa  which  transmits  the  anterior  palatine  vessels  and 
naso-palatine  nerves.  At  the  posterior  surface  upon  either  side 
is  a  groove  and  an  opening  for  the  transmission  of  the  posterior 
palatine  vessels  and  nerves.  Both  the  upper  and  lower  surfaces 
of  the  hard  palate  are  covered  with  mucous  membrane,  which 
extends  backward  and  unites  to  form  the  soft  palate.  Between 
the  two  folds  of  mucous  membrane  are  muscular  fibres  for  the 
purpose  of  moving  the  soft  palate  in  different  directions.  The 
shape  and  length  of  the  soft  palate  depends  upon  the  distance 
between  the  oesophagus  and  the  edge  of  the  hard  palate.  If 
the  head  of  the  individual  be  dolichocephalic,  or  long,  the  soft 


76  IRREGULARITIES    OF    THE    TEETH. 

palate  will  curve  slowly  backward,  thus  producing  quite  a  long 
space  between  the  incisor  and  uvula.  On  the  other  hand,  if  the 
person  possesses  a  brachycephalic,  or  short  head,  the  soft  palate 
will  curve  abruptly,  thus  allowing  only  a  short  distance  in  the 
vault  of  the  month.  I  have  observed  mouths  where  the  head 
was  so  short  from  front  to  back  that  the  soft  palate  descended 
almost  straight  down  without  the  slightest  curve.  The  vault, 
taken  as  a  whole,  presents  different  shapes  in  different  indi- 
viduals. 

The  mouth  of  a  child  at  the  fourlh  or  fifth  year,  normally 


<s 


Fig.  lil. 

presents  a  well-developed  jaw.  The  curves  are  all  graceful  in 
outline,  and  the  contour  of  the  dental  arch  is  well  formed. 
This  could  hardly  be  otherwise,  for  the  reason  that  the  jaw  is 
growing  rapidly  for  the  purpose  of  accommodating  the  per- 
manent teeth,  and  the  circle  of  the  alveolar  process  is  larger  than 
that  of  the  teeth.  Spaces  exist  between  the  teeth,  and  therefore 
crowding  cannot  take  place. 

As  a  matter  of  course  no  two  vaults  are  alike  in  height,  width 
or  contour,  although  each  is  normal  in  itself.  As  is  obvious 
from  the  chapter  upon  the  alveolar  process,  in  the  development 
of  the  jaws  are  two  structures,  the  hard,  dense  bone  of  the 
maxilla  and  hard  palate,  and  the  soft,  spongy  bone — the  alveolar 


DEVELOPMENT    OF    THE    VAULT.  77 

process.  The  maxillary  bones  develop  and  unite  at  the  median 
line.  The  contour  of  the  top  of  the  vault  is  now  established. 
It  is  held  in  position,  on  the  sides,  by  the  walls  of  the  antrum, 
supported  by  the  malar  process  and  by  the  anterior  alveolar 
process  and  maxillary  bone.  In  this  manner  the  vault  is  held 
in  its  natural  position.  The  maxillary  bones,  like  all  the  other 
bones  of  the  head,  develop  in  every  direction  in  a  general  way, 
until  the  growth  is  established.  Between  the  period  of  birth 
and  two  years  (when  all  the  temporary  teeth  are  in  place)  and 
twelve  or  fourten  years  (when  all  the  permanent  teeth  are  in 
position)  great  changes  take  place  in  the  shape  of  the  jaw. 
This  change  is  nicely  illustrated  in  Figs.  19  and  20. 


Fiji.  20. 

Fig.  19  illustrates  the  face  of  a  girl,  three  years  of  age,  the 
bones  of  the'  face  and  head  all  undeveloped.  The  bridge  of 
the  nose  is  sunken,  the  upper  lip  is  short,  as  well  as  the  jaw  from 
the  lower  lip  to  the  chin.  How  different  the  appearance  of  the 
same  girl  at  thirteen  (Fig.  20).  While  the  width  from  cheek 
to  cheek  has  not  changed  to  any  great  extent,  the  length  of  the 
face  from  the  chin  to  the  top  of  the  head  is  very  marked.  No 
part  of  the  face  has  changed  more  than  the  lower — from  the 
nose  down.  This  change  is  due  partly  to  the  change  in  the 
angle  of  the  lower  jaw,  and  partly  to  the  development  downward 
of  the  superior  alveolar  process.     In  young  life,  the  lower  jaw 


78  IRREGULARITIES    OF    THE    TEETH. 

presents  an  obtuse  angle ;  this  gradually  changes  until  at  middle 
life  it  assumes  a  right  angle.  In  order  that  the  alveolar  process 
and  teeth  may  cofnpensate  for  this  change  as  the  second  set 
comes  into  position,  the  alveolar  process  lengthens  with  the 
eruption  of  the  teeth.  This  is  proven  by  the  location  of  the  men- 
tal foramen,  which  is  situated  at  the  superior  border  of  the 
lower  jaw  early  in  life,  and  at  middle  life  just  midway  between 
the  upper  and  lower  border  cf  the  bone.  The  same  changes 
take  place  in  the  upper  jaw.  This  is  quite  noticeable  on  the 
sides  of  the  alveolar  process  at  the  roots  of  the  first  perma- 
nent molar  soon  after  it  has  eru]^  ted.  When  the  crowns  of  the 
bicuspids  are  ready  to  advance,  and  absorption  of  the  roots  of 


Fig.  21. 

the  temporary  molars  take  place,  there  is  some  irritation  in 
the  alveolar  process.  The  first  permanent  molar  coming  into 
position  advances  further  than  the  line  of  articulation  of  the 
temporary  molars,  and  the  pressure  of  the  jaws  rests  upon  the 
first  permanent  molars.  This  fact,  together  with  the  irritation 
already  mentioned,  has  a  tendency  to  lengthen  the  alveolar 
process,  so  that  when  the  bicuspids  come  into  place  there  is  a 
difference  in  the  height  of  the  vault.  There  are  plenty  of  illus- 
trations to  show  this  development  of  the  alveolar  process,  and 
every  practitioner  of  dentistry  has  observed  this. 

One   of  the   most   common  illustrations   is  that  when   the 
molar  teeth  upon  the  lower  jaw  have  been  extracted,  the  molars 


DEVELOPMENT    OK    THE    VAULT. 


79 


upon  the  upper  jaw  (for  want  of  antagonists)  drop  down  by 
the  lengthening-  of  the  alveolar  process.  The  difference  in  the 
height  of  vault  when  the  temporary  teeth  are  in  place  and  when 
the  permanent  teeth  erupt  is  nicely  illustrated  in  Fig.  21.  This 
cut  shows  the  permanent  incisors  and  first  molars  in  place.  Note 
the  lengthening  of  the  alveolar  process.  In  this  manner  the 
differences  in  length  of  the  face  occur.  In  those  cases  where 
the  vault  is  very  high,  the  alveolar  process  is  always  very  long 
and  thin.  '\'hv  depth  of  vault  is  also  governed  by  the  angle  of 
(he   jaw.      Tlius,  if   from   inherited  constitutional   disease,  such 


Fig.  2-2. 

as  consumption,  syphilis,  etc.,  arrest  of  development  of  the 
maxillae  should  ensue,  the  angle  would  not  change  from  an 
obtuse  to  a  right  angle.  It  will  be  noticed  that  when  the  mouth 
is  opened  the  anterior  part  has  to  travel  a  greater  distance 
than  the  posterior  part,  hence  either  the  anterior  inferior  alveolar 
process  will  elongate  so  that  the  lower  incisor  will  articulate 
with  the  upper  (Fig.  12),  or  the  anterior  superior  alveolar  process 
will  elongate  to  meet  the  lower  incisor  and  bicuspid.  Occa- 
sionally this  will  take  place  in  both  jaws.  In  either  case 
the  superior  alveolar  process  becomes  long  and  thin, 
and  the  vault  is  quite  high.     In  cases  of  arrest  of  development 


80  IRREGULARITIES    OF    THE    TEETH. 

of  the  bones  of  the  nose  and  adenoid  growths,  when  it  is 
impossible  for  the  child  to  breathe  through  the  nose,  and  mouth- 
breathing  is  a  necessity,  the  jaws  are  separated,  and  the  teeth 
not  having  a  resting  place,  the  alveolar  process  elongates  and 
a  high  vault  is  almost  always  noticed ;  hence  imbeciles  and 
degenerates  who  keep  the  mouth  open,  as  a  rule,  have  high 
vaults.  The  high  vaults  and  prominent  teeth,  and  upper  alveolar 
process  due  to  this  cause,  are  nicely  illustrated  in  Fig.  22,  etc. 
On  the  other  hand,  the  jaws  brought  closely  together  are  occa- 
sionally noticed.  This  is  due  (i)  to  a  short  ramus;  (2)  to  right 
angles  of  the  rami  to  the  body  of  the  jaw;  (3)  to  arrest  of 
development  of  the  alveolar  process,  and,  (4)  to  teeth  with  short 


Kig.  28. 

crowns,  or  teeth  not  fully  erupted.  In  such  cases  the  vault  is 
low,  the  alveolar  process  thick,  and  usually  the  lower  jaw  is 
quite  broad.  The  lips  pout,  the  face  is  short  and  broad.  Fre- 
quently the  upper  jaw  is  arrested,  in  its  development ;  the 
muscles  of  mastication  are  very  set  and  rigid.  Such  a  case  is 
illustrated  in  Fig.  23. 

The  height  of  the  vault,  then,  is  not  due  to  the  roof's  being 
pushed  or  pulled  up  by  a  pressure  exerted  through  the  vomer 
by  the  development  of  the  sphenoid  bone,  nor  does  the  shape 
of  the  base  of  the  skull  in  any  way  afifect  it,  as  I  have  already 
explained.  The  height  is  due  entirely  to  a  growth  downward 
of  the  alveolar  process  and  teeth.     The  extent  of  the  develop- 


DKVELOP.MKN  r    OK    TlIK    VAULT.  81 

ment  of  the  alveolar  process  depends  upon  equibalance  of  nutri- 
tion, harmonizing"  the  jaws,  alveolar  process,  and  Icni^th  of 
teeth.  That  the  distance  in  height  is  changed  from  a  child  to 
a  person  of  middle  life  is  demonstrated  by  the  following  figures  : 
Thus  in  317  children,  under  five  years  of  age,  before  the  develoj)- 
meiU  itf  the  first  permanent  molar  and  alveolar  process,  the 
lowest  vault  measured  .17;  the  highest  .62,  with  an  average  of 
.42.  In  the  height  of  vaults  in  children  at  different  ages,  there 
is  a  gradual  advance  in  the  height  of  the  vaults  until  in  4,614 
adult  vaults,  we  have:  lowest,  .21,  highest,  .84,  with  an  average 
of  .58.  It  will,  therefore,  be  observed  that  the  height  of  vault 
develops  about  .25  to  .33  in  depth  after  the  permanent  teeth 
commence  to  erupt.  Fig.  24  illustrates  an  instrument  invented 
by  me  for  the  purpose  of  measuring  these  cases ;  it  also  shows 
the  position  of  the  instrument  upon  the  model  when  the  meas- 
urement is  made. 

The  height  of  the  vauit  in  most  cases  is  far  below  the  average 
of  the  present  day.  In  4,614  measurements  of  normal  indi- 
viduals, made  by  the  author,  it  was  found  that  the  average  height 
of  the  arch  was  .58  of  an  inch;  the  measurement  was  made 
from  the  alveolar  border  betv^^een  the  second  bicuspid  and  the 
first  permanent  molar  to  the  height  of  the  arch.  The  average  of 
two  hundred  and  fifty-one  skulls  of  ancient  and  modern  Romans, 
Indians,  etc.,  was  .56 ;  allowing  for  the  thickness  of  the  mucous 
membrane,  the  average  height  of  the  vault  of  the  present  people 
would  be  a  little  below  that  of  the  Indians,  negroes,  ancient 
Britons  and  Romans.  In  908  measurements  of  the  vaults  of 
ancient  and  modern  Romans,  Peruvians.  Sandwich  Islanders, 
Mound  Builders.  American  Indians,  negroes,  etc.,  the  mini- 
mum height  of  vault  was  .25,  while  the  maxmium  height  was 
.88;  average,  .53.  On  comparing  these  figures  with  those  of 
modern  individuals,  the  lowest  vault  is  found  to  be  a  little  higher 
— .04 — than  in  modern,  and  the  highest  a  little  higher — .04.  The 
average,  however,  is  a  little  lower  than  in  the  modern  vaults 
by  .05,  thus  showing  that  the  ancient  and  race  pure  individuals 
possess  more  uniform  and  lower  vaults  than  modern.  The 
height  of  the  vault  hence  depends  upon  the  length  of  the  face 
from  the  chin  to  the  top  of  the  head.  So  far  as  the  height  of 
7 


82 


IRREGULARITIES    OF    THE    TEETH. 


the  vault  is  concerned,  no  race,  type,  sect,  or  intellect  can  lay 
claim  to  high,  medium,  or  low  vaults. 

What  are  the  elements  of  a  normal  vault  is  a  difificult  cj[ues- 


FiK.  24. 


DRVF.T.Ol'MI'.XT    OF    THF,    VAULT.  83 

tion  to  answer.  I  possess  six  skulls,  obtained  under  difficulties 
from  a  medical  college,  and  not  selected  for  any  particular 
purpose. 

The  lateral  measurement  was  made  between  the  roots  of  the 
second  bicuspids,  and  the  antero-postcrior  measurement  between 
the  central  incisors  at  a  point  intersecting  a  vertical  line  dropped 
from  the  posterior  nasal  spine  to  the  posterior  border  of  tlie 
palate  bone.  The  height  of  vault  was  taken  from  a  horizontal 
line  extending  from  the  alveolar  process  on  -one  side  to  the 
alveolar  process  on  the  opposite  side,  just  back  of  the  second 
bicuspid  teeth. 

The  following  measurements  were  taken  (see  Table  VI)  : 

Nos.  I  and  5  possess  very  much  the  same  contour  of  the 
dental  arch,  while  Nos.  4  and  6  are  very  broad,  with  square 
dental  arches. 

The  heights  of  the  vaults  are  all  different,  although  two  are 
flat,  while  the  others  are  more  or  less  rounding.  Yet  all  are 
normal,  while  no  two  are  alike. 

I  have  examined  hundreds  of  plaster  casts,  where  the  teeth 
were  all  in  a  fairly  normal  position,  with  similar  results. 

Of  372  skulls  of  Peruvians,  California  Indians,  Mound 
Builders,  and  American  Indians,  the  lateral  measurement  varied 
from  1. 12  to  1.75,  and  the  antero-posterior  from  1.75  to  2.75, 
while  the  height  of  the  vault  varied  from  .24  to  .75. 

Oakley  Cole  made  careful  measurement  of  a  number  of 
skulls,  chiefly  in  the  museum  of  the  College  of  Surgeons,  Lon- 
don, England.  The  skulls  examined  fall  into  two  series,  viz. : 
those  of  European  origin,  and  those  of  mixed  races,  with  the 
following  results  (see  Tables  VII  and  VIII)  : 

In  each  of  the  cases  that  I  have  examined,  the  dental  arch 
was  in  a  normal  condition.  I  have  also  examined  the  skulls 
mentioned  by  Oakley  Cole,  and  I  liave  been  unable  to  find  but 
few  contracted  arches  in  any  of  them.  If,  therefore,  in  the 
examination  of  thousands  of  skulls  having  normal  dental  arches, 
no  two  vaults  are  found  to  correspond,  it  is  evident  that  a 
normal  vault  is  one  where  the  dental  arch  is  regular,  and  the 
different  outlines  possess  graceful  curves,  regardless  of  height, 
width  and  length. 


84  IRREGULARITIES    OF    THE    TEETH. 

The  width  of  the  vault  depends  upon  two  factors :  First, 
the  development  of  the  jaw  bone  proper,  and,  second,  upon  the 
development  of  the  alveolar  process. 

Narrow  jaws  are  rarely  observed  among  pure  races.  In 
the  examination  of  the  thousands  of  skulls  of  early  races  in 
the  museums  of  Europe  and  this  country,  very  few,  if  any,  con- 
tracted vaults  are  found.  If  the  brain  is  in  a  healthy  condition 
and  the  child  properly  nourished,  the  jaw-bone  will  develop 
in  size  sufificiently  to  accommodate  all  the  teeth  when  they 
erupt.  The  teeth  will  crowd  against  one  another  as  they  come 
into  place,  and  a  normal  width  of  arch  will  be  produced.  If 
the  brain  be  defective,  as  the  result  of  some  of  the  constitutional 
diseases,  and  the  jaw  becomes  arrested  in  its  development  just 
before  sufficient  room  had  been  secured  for  the  teeth,  they  will 
crowd  against  one  another,  the  arch  will  become  broken,  and 
the  V  or  saddle  arch,  or  some  of  their  modifications,  will  be 
formed ;  hence  a  narrow,  contracted  vault.  The  amount  of  con- 
traction depends  upon  the  size  of  the  jaw'-bone  proper;  if  the 
bone  has  become  arrested  early,  the  jaw  being  small,  the  con- 
traction is  usually  very  great.  The  alveolar  process  depends 
entirely  upon  the  location  of  the  teeth  for  its  shape  and  size. 
Occasionally  the  teeth  (which  are  small)  are  inherited  from 
one  parent,  and  the  jaw-bone  proper  (which  is  large)  from  the 
other  parent.  In  such  cases  the  alveolar  process  sometimes 
contracts  until  teeth  antagonize,  when  a  small  arch  will  be  pro- 
duced. V  and  saddle  shape  arches  and  their  modifications  are 
observed  as  often  among  low  vaults  as  among  high  ones  in 
normal  jaws.  The  contraction  is  due  to  arrest  of  development  of 
the  jaw  at  the  time  of  the  eruption  of  the  permanent  teeth ;  the 
vault  may  be  high  or  low.  What  appears  to  be  a  high  vault  is 
not  in  the  height  of  the  vault,  but  in  the  width.  Having  novv 
explained  the  true  cause  of  what  appears  to  be  a  high  vault, 
what  Clouston  calls  neurotic  and  deformed,  are  found  to  be 
one  and  the  same.  Both  are  neurotic,  but  one  is  more  con- 
tracted than  the  other ;  both  are  due  to  arrest  of  development 
of  the  maxillary  bones.  There  are  high  and  low  vaults  among 
the  ignorant  as  well  as  the  intellectual,  among  the  colored  as 
well  as  the  white,  among  the  brachycephalic  and  mesocephalic 


DEVELOPMENT    OF    THE    VAULT.  85 

as  much  as  among  the  dolichocephalic,  among  the  deformed, 
or  contracted,  as  much  as  among  the  normal.  The  width  of 
the  vault  depends  upon  the  development  of  the  maxillary  bones ; 
if  it  develops  to  a  size  sufficient  to  accommodate  all  the  per- 
manent teeth,  it  will  be  a  normal  vault,  regardless  of  height. 
On  the  other  hand,  if  arrest  of  development  of  the  jaw  takes 
place,  these  deformities  result  in  a  V  or  saddle  arch  or  some 
of  their  modifications.  How,  then,  shall  vaults  be  classified? 
In  the  measurement  of  the  height  of  vaults  of  8,654  ancient 
and  modern  skulls  in  this  country  and  Europe,  the  highest  was 
.88,  the  lowest,  .25,  with  an  average  of  .53.  In  the  measurement 
of  6,387  mouths  of  persons  over  twenty  years  of  age,  the  highest 
is  .84,  the  lowest,  .21,  with  an  average  of  .58.  In  the  measure- 
ment of  616  insane  at  the  Eastern  Illinois  Insane  Asylum,  the 
highest  is  i,  lowest  .12,  with  an  average  of  .54. 

Taking  these  figures  into  consideration,  it  is  safe  to  average 
the  height  at  .55.  Allowing  .15  of  an  inch  in  each  direction, 
vaults  which  measure  below  .40  may  be  called  low  vaults ;  those 
between  .40  and  .70,  medium  vaults ;  those  above  .70,  high 
vaults.  We  could  still  classify  those  below  .25  very  low  vaults, 
and  those  above  .85  very  high  vaults.  The  width  of  vault  meas- 
ured between  second  bicuspids  and  first  permanent  molars 

In  8,654  ancient  and  modern  skulls  : 

Maximum    1.63 

Minimum     1. 13 

Average    1.36 

In  6,387  mouths  of  living  persons  over  twenty  years  of  age : 

Maximum    1.50 

Minimum     93 

Average    1.19 

In  616  insane  people  : 

Maximum    1.87 

Minimum 75 

Average   i .  16 

The  vast  difference  in  the  ancient  and  modern  skulls  of  this 
cotmtry  and  Europe,  with  those  of  living  individuals,  shows 
conclusively  that  the  jaws  are  diminishing  in  size.     A  standard 


86  IRREGULARITIES    OF    THE    TEETH. 

is  necessary  to  compare  the  width  of  the  vaults  as  they  occur 
to-day,  excluding  measurments  of  ancient  and  modern  skulls  and 
deformed  jaws.  Taking  the  1.19  as  the  average  width  of  vault, 
any  jaw  below  i  may  be  regarded  as  a  narrow  vault ;  one 
bewteen  i  and  1.40  medium  width,  and  one  which  measures 
above  1.40  a  wide  vault.^ 

"While  I  believe  that  the  views  of  Sergi  (The  Mediterranean  Race) 
are  justified,  still  they  have  not  as  yet  been  widely  accepted  by 
ethnologists  and  hence  must  be  considered  sub  judice.  His  position  in 
regard  to  the  division  of  skulls  into  Ellipsoides,  Ovoides,  Pentagonoides, 
Beloides  and  Trapezoides  is  in  my  judgment  justifiable  and  likely  to 
prove  of  great  advantage  in  craniology,  which  has  hitherto  been  rather 
hampered  by  the  paucity  of  its  classifications. 


CHAPTER    IX. 


DEVELOPMENT  OF  THE  PERIDENTAL  MEMBRANE. 

The  peridental  membrane,  like  the  periosteum  is  composed 
of  fibrous  tissue  covering  the  roots  of  the  teeth  and  lining  the 
inner  wall  of  the  alveolus.  They  are  both  derived  from  the 
mesoblastic  layer.  For  this  reason  there  can  be  very  little  differ- 
ence in  the  character  of  the  structure  of  each,  except  so  far 
as  the  function  is  concerned.  The  periosteum  is  made  up  of 
four  different  kinds  of  fibers.  An  outer  layer  of  coarse,  white 
fibrous  tissue,  an  inner  layer  of  fine,  white  fibrous  tissue,  elastic 
fibers  and  penetrating  fibers  (fibers  of  Sharpey). 

The  fibers  of  the  periosteum  are  coarser  than  those  of  the 
peridental  membrane.  The  coarser  fibers  run  parallel  with  the 
alveolar  process  over  the  border  and  extend  as  far  as  the  union 
of  the  epithelial  layer  and  the  periosteum. 

The  finer  fibers,  as  Black  has  shown,^  run  in  all  directions  and 
enter  the  alveolar  process  at  ever}^  point.  If  a  section  of  the  alveo- 
lar process  treated  with  acids  or  a  section  affected  by  halisteresis 
or  osteomalacia  be  placed  under  the  microscope,  the  fibers  are 
seen  to  retain  the  original  shape  of  the  bone. 

The  fibers  of  the  periosteum,  therefore,  are  continued 
throughout  the  process  from  the  periosteum  on  the  one  side 
to  the  peridental  membrane  on  the  other.  This  is  also  illus- 
trated in  the  mouths  of  persons,  where  (after  wearing  artificial 
dentures  for  a  short  time)  heat  produces  absorption  of  the  lime 
salts,  leaving  the  fibrous  tissues  intact. 

The  periosteum  is  abundantly  supplied  with  blood-vessels 
which  anastomose  w^ith  each  other  and  enter  the  alveolar  pro- 
cess at  the  Haversian  canals.  The  plexus  of  blood-vessels  is 
much  larger  proportionately  in  connection  with  the  alveolar 
process  than  with  other  bones  of  the  body,  owing  to  its 
transitory  nature. 

The  peridental  membrane  commences  at  the  margin  of  the 

^  Black:  Dental   Ligament. 

87 


00  IRREGULARITIES    OF    THE    TEETH. 

epithelium  at  the  neck  of  the  tooth  and  is  attached  directly  to 
the  cementum.  This  nicnibranc  has  various  functions;  First,  it 
fills  the  space  between  these  two  structures,  forming  a  cushion 
for  the  teeth  to  rest  upon;  second,  like  the  alveolar  process,  it 
is  present  only  when  the  teeth  are  present  and,  therefore,  devel- 
ops with  the  alveolar  process  when  the  first  teeth  erupt,  it  is 
entirely  lost  when  the  temporary  teeth  are  shed,  is  restored  with 
the  eruption  of  the  second  set  and  when  the  permanent  teeth 
are  extracted  it  disappears  with  the  alveolar  process;  third,  it 
furnishes  the  nourishment  for  the  teeth  while  thev  are  in  position 
in  the  jaw  and  holds  them  in  their  sockets. 

The  fibrous  tissue  in  its  earliest  stages  comprises  nearly  all 
or  quite  all  of  that  portion  of  the  jaw  which  eventually  becomes 
the  alveolar  process  (Fig.  261).  Calcification  begins  at  the 
center  of  the  jaws  and  gradually  closes  in  upon  the  fibrous  mem- 
brane until  it  becomes  the  thickness  of  a  sheet  of  paper.  In 
young  persons  the  membrane  is  much  thicker  than  in  old  age, 
since,  as  age  advances,  the  osteoblasts  on  the  one  hand  and  the 
cementoblasts  on  the  other  send  out  new  material  and  each 
wall  closes  in  upon  the  meml)rane,  which  becomes  very  thin 
in  old  age  and  almost  lost. 

The  fibers  which  comprise  this  membrane  extend  in  all 
directions  ;  some  crosswise  penetrating  the  cementum,  on  the 
one  hand  and  the  alveolar  process  on  the  other.  In  a  general 
way,  since  the  fibers  extend  though  the  alveolar  wall,  they  are 
more  closely  adherent  to  the  bone  than  to  the  cementum  and 
usually  cling  to  the  latter  when  the  tooth  is  removed.  It  will 
be  observed  that  these  fibers  do  not  enter  into  the  alveolar  pro- 
cess uniformly  as  claimed  by  Gray-  and  Pierce,'"'  like  tacks  or 
nails  driven  regularly  into  a  board  (the  fiber  of  Sharpey),  but 
vary  as  to  the  quantitv  in  difTerent  localities.  In  some  localities 
they  penetrate  in  large  quantities  and  almost  surround  a  piece 
of  alveolar  process,  while  a  few  fil)ers  penetrate  but  a  short 
distance.  In  some  jilaces,  thev  can  be  traced  almost  tlirough 
the  alveolar  process.  These  fibers  arc  much  finer  in  man  than 
in  the  lower  anim:!ls.     In  connection  with  the  fibers  which  pass 

-  Anatomy. 

^  American  Sy:  tern  of  Dentistry,  page  668. 


DKVI' '..or.Ml'.N  r    OK    'lllK    I'KKlDEN'rAL    MKMBKANE. 


89 


into  the  alveolar  process  arc  numerous  blood-vessels.  Others 
run  dias;onally,  and  still  others  lcnt;th\vise,  all  making  up  a 
tissue  which  holds  the  tooth  in  positi(jn  in  the  jaw.  The  fibers 
enter  the  i)cridcntal  membrane  at  all  points  of  the  process,  from 
its  maro-jn  to  tlic  ajH-x  of  the  roots.    Tbc  elasticity  of  this  mem- 


Fig.  25. 

Cross-section  of  Root,  Peridental  Membrane  and  Alveolar  Process. 
Radiation  of  Fibrous  Tissue.     (Noyes.) 

brane  is  so  great  that  in  correcting  irregularities  a  tooth  may 
be  turned  from  one-fourth  to  one-half  around  without  breaking 
the  fibers,  Fig.  25.  The  elasticity  is  greatest  in  youth.  As 
age  advances  the  membrane  grows  thinner  and  thinner  until, 
late  in  life,  there  is  almost  a  bony  union  between  the  tooth  and 


90 


IRREGULARITIES    OF    THE    TEETH. 


the  alveolar  process,  thus  preventing  stretching  of  the  fibers. 
At  the  upper  border,  under  the  gum  tissue  these  fibers  extend 
over  the  edge  of  the  alveolar  border  and  unite  with  the  fibers 
of  the  periosteum  on  the  outer  border  of  the  process,  forming 
the  interstitial  tissue. 


Fig.  26. 

X300.    No.  2.     Projective  Ocular  D.D.,  obj.  Zeiss.     Absorption  of  Alveolar 
Process.   I,  Fibrous  Tissue,  originally  Bone.    O,  Lacunar  Absorption. 

If  absorption  of  the  inorganic  substance  of  the  alveolar  pro- 
cess occur,  the  fibrous  tissue  retains  the  shape  of  the  process. 
The  same  results  when  inflammation  of  the  peridental  mem- 
brane takes  place  at  the  gum  margin  or  at  the  apex  of  the  root 
of  the  tooth,    What  was  once  alveolar  process  is  now  peridental 


DEVELOPMENT    OF    THE    PERIDENTAL    MEMBRANE.  1)1 

membrane  or  fibrous  tissue,  Fig.  26.  When  pressure  is  applied 
in  regulating  teeth,  the  lime  salts  are  absorbed  and  the  results 
are  obtained. 

Two  kinds  of  structures  are  present  in  the  alveolar  process, 
a  dense,  compact,  hard  structure  (composed  of  lime  salts)  and 
a  fibrous  tissue ;  either  alone  will  retain  the  shape  of  the  alveolar 
process. 

Blood-vessels  permeate  this  membrane  throughout  from  the 
gum  tissue  at  the  neck  of  the  tooth  through  the  alveolar  walls 
to  the  end  of  the  roots.  They  are  most  abundant  in  youth. 
Capillary  blood-vessels  (vessels  of  von  Ebner)  enter  the  bone 
and  Haversian  canals  through  the  process  and  into  the  peri- 
dental membrane.  Many  of  these  blood-vessels  extend  the 
entire  length  from  the  gum  margin  to  the  apex  in  straight  lines 
and  vice  versa.  A  great  supply  of  blood-vessels  penetrates  the 
membrane  through  the  alveolar  walls.  These  vessels  unite  and 
anastomose  with  the  arteries  which  traverse  lengthwise,  forming 
a  complicated  plexus.  According  to  some  writers  the  vascular 
supply  of  the  peridental  membrane  is  situated  in  the  center  of 
the  structure.  This  has  not  been  my  experience.  All  of  my 
slides  as  well  as  those  here  presented  show  the  blood-vessels 
to  be  situated  nearest  the  alveolar  process.  It  is  quite  natural 
that  this  should  be  so,  since  very  little  blood  is  required  for  the 
nourishment  of  the  cementum,  while  the  largest  amount  is 
required  to  supply  the  alveolar  process.  The  system  of  blood- 
vessels situated  in  the  peridental  membrane  and  showing  their 
relation  to  the  surrounding  tissue  can  be  well  shown  in  injected 
specimen  from  healthy  dogs."*  The  vessels  seen  in  the  mem- 
brane anastomose  very  freely  with  those  at  the  gum  margin, 
showing  the  membrane  to  be  well  nourished  in  all  its  parts. 
Should  one  part  become  involved  by  disease  the  other  parts  are 
over-nourished  in  consequence. 

These  blood-vessels  enter  the  alveolar  walls  with  the  fibrous 
tissue  through  the  Haversian  canals  and  these  in  turn  permeate 
the  entire  bone.  As  age  advances,  however,  the  bone  becomes 
more  dense  and  the  Haversian  canals  become  smaller  and 
(Under  certain  conditions)  cease  to  exist.     When  disease  takes 

•*  Interstitial  Gingivitis,  page  40. 


92  IRREGULARITIES    OF    THE    TEETH. 

place,  either  at  the  gingivus  or  at  the  apex  of  the  root,  the 
supplv  of  blood  being  thus  cut  off,  the  tissues  receive  sufficient 
nourishment  through  the  alveolar  wall.  Since  the  structures  are 
in  a  transitory  state,  being  destroyed  and  repaired  so  frequently, 
it  is  evident  why  the  blood  supply  is  so  rich. 

As  I  have  elsewhere  shown  an  inflammatory  process  goes 
on  not  merely  in  the  slightest  movement  of  the  teeth  in  regu- 
lating, but  likewise  in  the  eruption  of  the  teeth  as  well  as  in 
absorption  of  the  alveolar  process  after  extraction.  There  is 
great  individual  variation  from  many  causes  in  this  particular. 
The  amount  of  tension  will,  therefore,  in  a  measure  depend  upon 
the  individual  idiosyncrasy.  The  operator  must  decide  upon 
the  extent  of  force  to  be  applied  in  a  given  case.  The  influence 
of  bending  the  alveolar  process  must  depend  to  a  greater  or 
lesser  extent  upon  the  resultant  absorption. 


CHAPTER   X. 


DEVELOPMENT  OF  TPIE  TEETH. 

The  teeth,  as  Minot  remarks,  were  primitively  organs  of  the 
skin  and  widely  developed  over  the  surface  of  the  body.  They 
played  an  important  part  in  the  development  of  the  skeleton. 
The  dermal  bones,  which  form  part  of  the  skull,  were  originally 
teeth.  The  placoid  scales,  which  were  dermal  teeth  in  the  shark, 
helped  out  the  deficiencies  of  brain  case.  This  was  cartilaginous 
and  essentially  the  chondrocranium  or  primitive  cartilage  skull  of 
the  human  embryo,  formed  from  the  vertebrje,  but  insuf^cient 
to  cover  the  brain,  ever  increasing  with  evolution.  The  tooth 
is  a  papilla  which  projects  into  the  epidermis  and,  ossifying  (cal- 
cifying) in  a  particular  way,  changes  into  ivory  around  the 
soft  core  or  pulp.  To  the  papilla  the  epidermis  adds  a  layer  of 
enamel.  The  tooth  proper  departs  from  the  primitive  method 
of  development  since  it  does  not  arise  on  the  surface  but  deep 
down.  The  dentiferous  epithelium  grows  down  into  the  dermis 
forming  an  oblique  shelf,  which  is  a  special  tooth  forming  organ. 
On  the  under  side  of  the  shelf  the  teeth  are  developed  in  the 
same  way  as  over  the  skin  although  they  are  very  nuich  larger. 
The  teeth  are,  however,  in  various  stages  of  development  and 
only  one  is  fully  exposed.  When,  as  happens  in  time,  it  falls, 
the  next  tooth  behind  replaces  it.  Since  the  production  of  new 
tooth  germs  goes  on  in  adult  life,  replacement  of  teeth  in  the 
shark's  jaw  continues  indefinitely,  hence  sharks  are  termed  poly- 
phyodont.  Mammals  have  but  two  sets  of  teeth  and  are  called 
diphyodont.  The  teeth  proper  unite  with  a  small  plate  of  dermal 
bone  at  its  base.  By  a  modification  of  the  jaws,  the  epidermis 
first  grows  into  the  dermis  and  the  dermal  tooth  papilla  is 
developed.  The  first  indication  of  tooth  germs  in  mammals  is 
a  thickening  of  the  epithelium  covering  the  jaw.  This  thick- 
ening, which  appears  as  a  ridge  during  the  sixth  w-eek  of  embry- 
onic life,  forms  on  the  under  side  of  the  epithelium.  This  curv- 
ing ridge    expands   into   an   outer  portion   (the   outline   of  the 

93 


94  IRREGULARITIES    OF    THE    TEETH. 

groove  between  the  lip  and  the  gum)  and  an  inner  portion,  the 
dental  shelf  which  grows  obliquely  inward.  The  papilla  for  the 
milk  teeth  are  formed  on  the  under  side  of  the  shelf  and  it  is 
thus  possible  to  continue  growing  toward  the  lingual  side  so 
that  the  second  set  of  germs  is  thus  developed  for  the  permanent 
teeth.  -  The  end  of  the  shelf,  toward  the  articulation  of  the  jaws, 
is  prolonged  without  retaining  the  direct  connection  with  the 
epithelium  and  from  this  prolongation  arise  the  enamel  organs 
for  the  three  permanent  molars.  Wherever  a  tooth  germ  arises, 
the  dental  shelf  is  locally  enlarged  and  the  local  enlargement 
constitutes  an  enamel  organ  which  projects  from  the  under  side 
of  the  shelf.  Mammal  teeth  pass  in  evolution  from  the  simple 
types  of  the  oviparous  edentates  to  those  of  the  indeciduous  an- 
cestors of  the  sloths  and  armadilloes  and  their  descendants,  inclu- 
sive of  the  dolphins  and  whales,  whose  teeth  (in  the  foetal  Green- 
land whale  and  adult  Sperm  whale)  preserve  this  old  type. 
While,  as  in  the  edentates,  these  teeth  may  be  few,  they  may 
also,  as  in  the  insectivorous  mammals,  approximate  those  of  the 
reptilia  in  number  (sixty  or  seventy  on  a  side)  and  characteristic 
location. 

The  evolution  of  this  primitive  tooth  to  the  bicuspid  and 
molar  type  results  from,  as  I  have  elsewhere  shown,  concres- 
cence and  differentiation.  The  human  lower  molar  with  its  low 
quadritubercular  crown  has  evolved  by  addition  of  cusps  ajid  by 
gradual  modeling  from  a  simple  high  crown  pointed  tooth. 

The  tooth  has,  as  Havelock  Ellis^  points  out,  been  but  little 
considered  from  anthropologic  and  ethnologic  standpoints. 
Flower,  however,  has  constructed  a  dental  index  by  multiplying 
the  dental  length  by  lOO  and  dividing  by  the  basio-nasal  length 
(or  length  from  the  naso-frontal  suture  to  the  foramen  magnum). 
According  to  his  results  thus  obtained  the  white  or  Caucasic 
races  are  microdont  (with  small  teeth  and  small  dental  index). 
The  yellow  or  Mongolic  races  are  mesodont  (middle  teeth  and 
index).  The  black  races  are  megadont  (great  teeth  and  index). 
The  anthropoid  apes  have  still  larger  indices  and  teeth. 

In  addition  to  the  rudiments  of  the  enamel  organs  for  the 
milk   and   permanent   teeth,    there   are    addtional   organs   often 

1  Man  and  Woman. 


DEVELOI'MKNT    OF    THE    TEETH.  95 

present  in  a  very  variable  condition  and  number  nearer  the 
external  surface,  and  are  exceedingly  similar  to  the  youngest 
stages  of  the  normal  enamel  organs.  According  to  Kollmann 
and  Gegenbauer  they  are  abortive  rudiments,  survivals  from  an 
ancestral  condition  in  which  teeth  are  more  numerous.^  Black^ 
speaks  of  these  as  glands,  while  Ch.  Robin  and  Magitot,-*  who 
were  the  first  to  describe  them,  claim  they  are  epithelial  debris ; 
a  view  perfectly  compatible  with  that  of  Gegenbauer  and  Koll- 
mann. My  own  researches^  corroborate  the  results  of  Robin  and 
Magitot. 

-  DeMoor,  Evolution  by  Atrophy. 
3  Dental  Cosmos,  Feb.,  1899. 

*  Genesis  and  Development  of  the  Dental  Follicle,  Journal  de  Physiol- 
ogic de  Brown-Sequard,  i860. 
"  Interstitial  Gingivitis. 


CHAPTER   XI. 


SOCIAL  CONSANGUINITY,  NEAR-KIN,  EARLY  AND 
LATE   MARRIAGE. 

From  the  general  principles  of  heredity  already  laid  down 
it  must  be  obvious  that  the  influence  of  intermarriage  in  fam- 
ilies has  been  over-estimated  as  a  factor  per  se  in  producing 
defect.  The  idea  of  the  advantage  of  cross-breeding,  which 
seemingly  appeared  in  the  practice  of  exogamy  (marriage  outside 
the  tribe  or  more  often  outside  those  having  the  same  totem  or 
coat-of-arms)  arose,  as  I  have  elsewhere  shown,^  from  obser- 
vation of  deformities,  following  intermarriages  contracted  after 
the  killing  of  girls  for  economic  reasons  had  led  to  exogamy. 
The  idea  of  incest-  was  of  religious  origin  rather  than  innate, 
since  totemic  relationship  (which  was  chiefly  prohibited)  was 
often  far  from  being  consanguinous.  The  totem  was  a  mark 
indicating  descent  from  a  supposed  animal  ancestor  endowed 
with  occult  powers.  The  children  with  the  Bear  totem  of  one 
tribe  could  not  marry  those  having  the  Bear  totem  of  any  other 
tribe.  From  this  practice  sprang  the  medical,  theologic  and 
legal  notions  anent  the  danger  from  marriages  of  consanguinity, 
which,  as  D.  Hack  Tuke^  remarks,  insisted  upon  from  time  to 
time  by  medical  writers,  has  been  recognized  by  ecclesiastic 
authority,  civil  law  and  by  popular  feeling.  By  ecclesiastic  and 
civil  law,  marriage  of  those  very  nearly  related  has  been  for- 
bidden on  other  grounds  than  that  of  alleged  danger  to  offspring. 
At  the  same  time  the  justice  of  such  laws  receives  support  from 
medical  observations,  which  tend  to  show  that  intermarriage 
may  produce  degeneracy,  idiocy  and  insanity.  I  have  elsewhere 
analyzed^  this  evidence  and  shown  for  the  facts  there  is  more 
than  one  explanation.  The  explanation  pointed  out  by  Strahan"* 
underlies  the  chief  danger  in  intermarriages.     With  a  perfectly 

^  Degeneracy  :   Op.   Cit. 

-  Durkheim  Annee  Sociologiquo,  1898. 

3  Psychological    Dictionary. 

*  Marriaee  and  Disease. 

96 


SOCIAL    CONSANGUINITY,    KARLY    AND    LATH    MARRIAGK.  07 

healthy  stock,  as  every  breeder  of  animals  knows,  remarks 
Strahan,  "in-and-in  breeding"  may  be  practiced  with  impunity, 
but  where  the  stock  is  tainted  with  disease  or  imperfection,  safety 
is  only  to  be  found  in  "crossing." 

The  error  of  the  old  doctrine  upon  which  was  founded  the 
prohibition  of  consanguinous  unions  lay,  as  Strahan  remarks, 
not  in  asserting  that  disease  and  deformity  were  more  often  met 
with  in  children  of  these  than  those  of  other  unions,  for  such 
is  the  fact,  but  in  attributing  these  unhappy  results  merely  to 
parental  blood  kindred.  Over  and  above  the  fact  that  these 
consanguinous  marriages  are  almost  certain  to  transmit,  in  an 
accentuated  form,  defect  or  tendency  to  disease  already  present 
in  the  family,  there  is  no  physiologic  reason  why  such  marriages 
should  not  take  place.  Breeders  of  prize  stock  frequently  breed 
"in-and-in"  not  only  with  impunity  but  with  marked  benefit. 
But  this  fact,  while  going  to  prove  that  it  is  not  the  mere  blood 
relationship  of  the  parents  which  induces  the  degeneration  so 
often  found  in  the  children  of  consanguinous  marriages,  can  but 
rarely  be  advanced  as  an  argument  in  support  of  the  marriage  of 
blood  relations.  The  stock-raiser  only  permits  the  more  perfect 
members  of  his  flock  and  herds  to  continue  their  kind  ;  for  this 
reason  "in-and-in"  breeding  is  innocuous  just  as  it  would  be  in 
the  human  family  under  like  conditions. 

Recently  acquired  characters,  whether  physiologic  or  patho- 
logic, are  very  liable  to  disappear  when  the  individual  bearing 
such  characters  intermarries  with  another  not  having  the  same 
character.  The  natural  tendency  in  all  such  cases  is  to  revert 
in  the  offspring  to  the  normal  type,  so  that  unless  the  new 
character  be  very  deeply  impressed  upon  the  parental  organism, 
it  is  almost  certain  it  will  not  appear  in  the  offspring  of  the 
other  parents  having  nothing  of  the  character.  But  when  both 
parents  are  possessed  of  the  character,  whether  it  be  physiologic 
or  pathologic,  this  natural  tendency  to  revert  to  the  original 
is  often  overborne  and  the  character  is  repeated  in  an  accentu- 
ated form  in  the  offspring. 

Now  this  accentuation  of  family  characters  is  what  must 
always  happen  in  the  case  of  consanguinous  marriages.  If  there 
be  taint  in  the  family,  each  member  will  have  inherited  more  or 


98  IRREGULARITIES    OF    THE    TEETH. 

less  of  it  from  the  common  ancestor.  Take  the  case  of  cousins, 
the  descendants  of  a  common  grandparent  who  was  insane  and 
of  an  insane  stock.  Here  the  cousins  are  certain  to  have  inher- 
ited more  or  less  of  the  insane  diathesis.  Even  if  the  taint  have 
been  largely  diluted  in  their  case  by  the  wise  or  more  likely 
fortunate  marriages  of  their  blood  related  parents,  yet,  still  they 
have  inherited  a  certain  tendency  to  nervous  disease  and  if  they 
marr}-  they  must  not  be  surprised  if  that  taint  appear  in  aggra- 
vated form  in  their  children.  Some  children  of  such  parents 
are  idiotic,  epileptic,  dumb  or  lymphatic  and  the  parents  marvel 
whence  came  the  imperfection.  In  some  cases  the  parents  and 
possibly  grandparents  of  the  unfortunate  children  have  not  dis- 
played any  obvious  evidence  of  the  tendency  to  disease  which 
they  have  inherited  and  handed  on  to  their  descendants.  Not 
looking  farther  back  the  parents  boldly  assert  that  such  a  thing 
as  insanity,  epilepsy,  scrofula,  etc.,  is  unknown  to  their  family. 
They,  themselves,  have  never  been  insane ;  why,  then,  should 
their  children?  In  like  manner  children  may  be  epileptic,  blind, 
deaf-mute,  lymphatic,  cancerous,  criminal,  drunkards  or 
deformed  from  direct  inheritance  and  yet  the  family  line  be  hon- 
estly declared  to  be  healthy.  The  truth  of  Sir  William  Aitken's 
maxim  (that  "a.  family  history  including  less  than  three  gener- 
ations is  useless  and  may  even  be  misleading")  is  hence  obvious. 
Similarity  of  temperament  induced  by  a  common  environment 
Vvhich  Strahan  calls  "social  consanguinity"  is,  hence,  also  a 
potent  factor  in  the  production  of  all  hereditary  degenerations. 
Living  under  similar  customs,  habits  and  surroundings,  labor- 
ing at  the  same  occupation,  indulging  in  the  same  dissipation, 
tend  to  engender  like  diseases  and  degenerations  irrespective  of 
any  blood  relationship.  Hence,  it  not  seldom  happens  that 
persons  not  even  distantly  related  by  blood,  are  in  reality 
much  more  nearly  related  in  temperament  than  cousins  or  even 
nearer  blood  relations  who  have  experienced  widely  different 
modes  of  life.  This  "social  consanguinity"  is  the  great  curse 
which  dogs  every  exclusive  tribe  and  class  and  hurries  them  to 
extinction.  It  has  largely  added  to  real  or  family  consanguinity 
in  the  production  of  the  disease  and  degenerations  which  have  so 
heavily  fallen  upon  the  aristocracies  and  royal  families  of  Europe. 


SOCIAL    CONSANGUINITY,    KARLY    AND    LATH    MARRIACiK.  99 

This  "social  consanguinity"  appears  likewise  in  the  tendency 
of  the  neurotic  to  intermarry,  popularly  expressed  in  the  proverb 
that  "like  clings  to  like."  This  likeness  which  is  in  mental  char- 
acteristics has  been  shown  to  be  present  by  Roller,  de  Monteyel, 
Kiernan,  Bannister  and  Manning,  so  far  as  Germany,  France, 
the  United  States  and  Australia  are  concerned.  Bannister  puts 
the  statistic  proof  of  this  tendency  thus  forcibly :  "There  are  in 
Illinois,  according  to  the  most  recent  estimates,  in  round  num- 
bers, about  6,000  insane,  or  one  to  a  little  over  500  of  the  popu- 
lation. Even  if  we  double,  treble  or  quadruple  this  frequency 
to  include  all  that  have  been  or  are  to  be  insane,  as  well  as 
those  insane  at  the  present  time,  it  would  not  appear  that  there 
was  much  probability  of  two  insane  persons  being  married 
according  to  any  ordinary  law  of  chances.  In  fact,  we  find  four 
out  of  the  104  with  insane  heredity  had  both  father  and  mother 
been  insane.  In  one  of  these  cases  the  insane  heredity  involved 
both  parents  and  grandparents  on  each  side,  though  in  the  case 
of  the  latter  the  histories  show  it  only  as  collateral.  Besides  these 
three  patients  direct  paternal  and  collateral  maternal  heredity, 
two  had  direct  maternal  and  collateral  paternal  heredity  and  in 
one  case  there  was  collateral  heredity  of  insanity  on  both  sides. 
This  makes  altogether  nearly  10  per  cent  of  those  with  insane 
heredity  with  it  on  both  sides,  maternal  and  paternal,  and  thus 
favored  with  a  double  opportunity  to  inherit  mental  disease.  If 
to  this  be  added  the  instances  where  with  insanity  of  one  parent 
there  is  either  epilepsy,  hysteria,  or  drunkenness,  brain  disease, 
nervousness,  etc.,  of  the  other,  the  ratio  of  double  inheritance 
rises  to  over  20  per  cent." 

Since  jaws  and  face  are  transitory  structures,  but  relatively 
little  taint  is  needed  in  a  family  or  community  to  cause  degen- 
eration of  the  face  and  jaws  and  irregularities  of  the  teeth.  The 
influence  of  this  factor  of  these  neurotic  and  "social  consanguin- 
ity" tendencies  in  the  production  of  deformities  of  the  face  and 
jaws  and  irregularities  of  the  teeth  cannot  well  be  over-estimated. 
A  test  of  these  influences  is  alleged  to  exist  in  the  Polynesian 
populations  of  the  Pacific  Islands,  where  race  admixture  can  be 
excluded  for  a  relatively  long  period.     Concerning  the  ancient 


100  IRREGULARITIES    OF    THE    TEETH. 

Hawaiians,  J.  M.  Whitney^  remarks  :  "Here  is  a  people  isolated 
from  all  others  for  at  least  1,400  years  with  no  admixture  of 
races,  yet  irregularity  of  the  teeth  of  both  maxillae  is  almost  as 
common  as  it  is  among  the  mixed  races  of  to-day."  In  social 
consanguinity  of  the  Polynesians  must  be  peculiarly  reckoned 
their  excessive  and  systematized  licentiousness,  shown  in  socie- 
ties for  practice  of  extreme  sexual  indulgence,  like  the  Areoi.^ 
Such  societies  undoubtedly  create  neurotic  states  and  tendencies 
and  produce  more  marked  degeneracy  of  the  face,  jaws  and  teeth 
than  intermixture  of  race  or  consanguinous  marriage.  The  factors 
of  race  admixture  cannot,  as  Denniker'^  has  shown,  be  completely 
excluded  from  consideration  among  the  ancient  Hawaiians. 
Since  leprosy,  like  syphilis,  may  simply  check  development  with- 
out causing  infection  in  utero,  this  factor  has  likewise  to  be 
taken  into  consideration.  Furthermore,  as  Alvarez,^  of  Waialu, 
Dahu,  has  shown,  the  mortality  among  Hawaiian  babes  is  very 
large.  Hygiene  is  practically  unknown  to  the  mothers.  Kava- 
Kava  (the  fermented  juice  of  the  ava)  is  the  great  medicinal 
agent  of  the  Kahuna  (sorcerer-medicine  man),  who  is  the  chief 
medical  resource  of  the  natives.  Syphilis  is  very  common,  espe- 
cially the  non-venereal  type.  The  habits  of  the  natives  aid  the 
spread  of  the  disease.  Under  such  conditions,  irregularities  must 
result.  The  age  of  the  mother  at  pregnancy  is  too  much  ignored 
in  dealing  with  defects.  J.  Mathews  Duncan^  pointed  out  nearly 
two  decades  ago  that  the  offspring  of  early  and  senile  marriages 
were  defective.  Multiple  and  too  nearly  repeated  pregnancies 
were  of  frequent  occurrence.  Conger^*^  (whose  results  were 
later  corroborated  by  Joseph  Workman^  ^  and  Kiernan)  points 
out  that  in  all  degenerate  forms,  age  of  the  parent  must  be 
taken  into  consideration,  since  it  alone  often  determines  degen- 
eracy. Conger  found  that  the  age  of  the  mothers  of  degenerates 
is  often  below  twenty-five  years.     Korosi,^^  in  an  investigation 

^  The  World's  Columbian  Dental  Congress  Transactions,  page  109. 

^  Schultze :   Fetichism. 

■^  Races  of  Men. 

*  Pacific  Medical   Journal,   1893. 

^  Sterility,  Fecundity  and  Allied  Topics. 

"•11.  Manicomo,  May,  1886. 

11  Alienist  and  Neurologist,   1887. 

"  Orvosi  Hetilap,  1894. 


SOCIAL    CONSANGUINITY,   KARLY    AND    LATE    MARRIAGE.       101 

of  the  influence  of  the  age  of  parents  on  the  vitality  of  children 
found  that  the  proportion  of  deaths  among  children  from 
unhealthy  constitutions  or  maladies  traceable  to  the  mother  was 
twice  as  large  among  the  children  of  mothers  under  twenty 
as  among  the  children  of  mothers  over  thirty.  The  healthiest 
ofTspring  are  born  of  mothers  between  twenty  and  thirty,  united 
to  husbands  between  thirty  and  forty.  Where  either  husband 
or  wife  was  under  twenty,  the  offspring  usually  proved  weakly. 
This  is  particularly  the  case  even  in  Hungary,  where  the  girls 
become  women  at  thirteen.  In  that  country  in  25  per  cent  of  the 
number  of  marriages  the  brides  are  under  twenty  years  of  age. 
Marro^^  finds  that  among  all  classes  of  criminals  there  is  an 
excess  of  immature  parents  (under  twenty-five)  or  senile  parents 
(over  forty-two).  As  I  have  elsewhere  remarked,  it  is  a  well 
known  experience  that  the  children  of  the  aged  readily  show 
degenerate  types.^'*  Arthur  Mitchell  arid  Langdon  Down  have 
recognized  the  influence  of  both  premature  and  late  marriage 
in  the  production  of  idiocy.  Factors  capable  of  producing  idiocy 
may  arrest  foetal  development  at  all  stages.  Kiernan^s  has  had 
under  observation  a  Nova  Scotian  family  of  Scotch  extraction, 
the  mother  of  which  continued  to  bear  children  until  she  was 
sixty-three  years  old.  There  had  been  no  pregnancy  between 
fifty  and  fifty-six.  At  fifty-six  a  son  was  born  who  had  ear, 
jaw  and  skull  stigmata  and  became  a  periodical  lunatic  at  twenty- 
five.  A  son  born  a  year  after  was  a  six-fingered  idiot  with 
retinitis  pigmentosa.  Three  of  the  next  children  were  paralytic 
idiots  in  infancy.  One  of  the  next  children  was  a  periodical 
sexual  invert  female.  The  last  child  was  an  epileptic.  The 
children  born  before  the  age  of  fifty  were  normal  and  averaged 
sixty  years  of  age. 

13  La  Puberta,  1898. 
1*  Degeneracy,  Op.  Cit. 
15  Detroit  Lancet,  1882. 


CHAPTER  XII. 


ENVIRONMENT,   CLIMATE,  SOIL  AND   FOOD. 

The  influence  of  climate,  soil,  food  and  other  factors  of  the 
immediate  environment  was  obvious  to  very  early  observers. 
According  to  Hippocrates,^  "race  is  the  daughter  of  climate." 
The  seeming  modifications  produced  have  made  an  impression 
even  on  skeptical  biologists  like  Weismann,^  who  admits  that 
"the  possibility  is  not  to  be  rejected  that  influences  continued 
for  a  long  time  (that  is,  for  generations,  such  as  temperature, 
climate,  kind  of  nourishment,  etc.,)  which  may  afTect  the  germ 
plasm  as  well  as  any  other  part  of  the  organism,  may  produce  a 
change  in  the  constitution  of  the  germ  plasm.  But  such  influ- 
ences would  not  then  produce  individual  variations,  but  would 
necessarily  modify  in  the  same  way,  all  the  individuals  of  a  spe- 
cies living  in  a  certain  district.  It  is  possible,  though  it  cannot 
be  proved,  that  many  climatic  varieties  have  arisen  in  this  man- 
ner. Possibly  other  phenomena  of  variations  must  be  referred 
to  a  variation  in  the  structure  of  the  germ  plasm  produced 
directly  by  external  influences." 

The  influence  of  climate  depends  upon  more  than  the  mere 
range  of  temperature  and  meteorologic  elements.  Transferral 
from  a  sub-temperate  to  a  sub-tropic  clime  means  not  merely 
a  change  in  the  necessity  for  adaptation  to  temperature  altera- 
tions, but  also  change  in  the  ease  with  which  food  is  produced 
and  the  stress  of  the  struggle  for  existence  to  which  man  has  been 
exposed.  One  of  the  most  interesting  changes  apparently  due 
to  the  influence  of  soil  and  climate  was  that  of  the  Wurtem- 
burgers,  who  settled  82  years  ago  near  Tifli>,  Russian  Georgia.^ 
They  originally  had  fair  or  red  hair,  light  or  blue  eyes  and 
broad,  coarse  features.  In  the  first  generation,  brown  hair  and 
black  eyes  became  the  rule,  while  the  lace  acquired  a  noble,  oval 

1  Works  Sydenham   Edition. 

2  The  Germ  Plasm. 

^  Keane,  Ethnology,  page  283. 

102 


ENVIRONMF.NT,     CLIMATE,     SOIL    AND    FOOD.  103 

foriiL  Tliese  changes  were  due  entirely  to  the  surroundings,  as 
no  instance  of  crossing  with  Georgian  neighbors  was  on  record. 
These  Wurteniburgers  continued  to  speak  (icrinan  uninfluenced 
by  local  dialects.  The  Suabians,  however,  were  a  mixed  race 
in  whom  the  surroundings  in  Wurtcmburg  tended  to  develop 
one  type  while  those  in  Georgia  tended  to  develop  another.  The 
changes  in  the  face,  jaw  and  teeth  consequent  in  these  changes 
in  type  became  clearly  evident.  The  original  Wurtemburger 
type  had  arrested  facial  development  and  prognathism,  which 
disappeared  under  the  favorable  conditions  of  Russian  Georgia. 
The  instance  illustrates  very  clearly  the  changes  which  have 
produced  the  alleged  transformation  of  the  Britisher  into  the 
Yankee,  commonly  cited  in  illustration  of  the  supposed  effects 
of  soil  and  climate.  Over  three  decades  ago,-^  ^ogt  remarked 
that  American  Anglo-Saxons  or  Yankees  were  instanced  as  illus- 
trations of  change  of  character.  Already  after  the  second  gener- 
ation, according  to  Pruner-Bey,  the  Yankee  presents  features 
of  the  Indian  type.  At  a  later  period  the  glandular  system  is 
reduced  to  the  minimum  of  its  moral  development.  The  skin 
becomes  like  leather.  The  color  of  the  cheeks  is  replaced  by 
sallowness.  The  head  becomes  smaller  and  rounder  and  is 
covered  with  stifT,  dark  hair.  The  neck  becomes  longer. 
There  is  greater  development  of  the  cheek  bones  and  the  mas- 
seters.  The  temporal  fossae  become  deeper,  the  jawbones  more 
massive,  the  eyes  lie  in  deep  approximated  sockets.  The  iris 
is  dark.  The  glance  is  piercing  and  wild.  The  long  bones 
especially  in  the  superior  extremities  are  lengthened  so  that  the 
gloves  manufactured  in  England  and  France  for  the  American 
market  are  of  a  peculiar  make  with  long  fingers.  The  female 
pelvis  approaches  that  of  the  male.  According  to  Ouatrefages, 
America  has  thus  from  the  English  race  produced  a  new  white 
race  which  might  be  called  the  Yankee  race.  This  hypothesis 
has  of  late  been  strongly  urged  before  the  Chicago  Academy 
of  Aledicine  by  F.  W.  Starr,  Professor  of  Anthropology  in  the 
University  of  Chicago,  but  no  new  facts  favorable  to  it  have  been 
adduced.-''      AMth    improved    conditions    in    New    England   this 


*  Lectures  on  Man,  1869. 

5  Journal  of  the  American  Medical  Association,  Vol.   XXXV. 


104 


IRREGULARITIES    OF    THE    TEETH. 


accentuation,  however,  began  to  disappear.  In  place  of  the  New 
England  type  assuming  increased  Indian  characteristics,  the 
reverse  became  the  case.  In  the  following  illustration,  four 
generations  of  a  New  England  family  with  a  Scandinavian  patro- 
nymic are  represented.  The  changes  are  as  striking  as  those 
which  occurred  in  the  Suabian  before  mentioned.  The  first 
generation  (born  in  1761)  is  represented  by  a  dolichocephalic 
head  (Fig.  27)  with  massive  jaws  and  lips  (especially  the  upper) 
prominent.  The  nose  is  long.  The  eyes  are  set  close  together. 
The  forehead  is  very  high  and  straight.     In  the  second  genera- 


Fig.  27.  Fig.  28. 

tion  (Fig.  28)  the  face  is  not  so  long.  The  lateral  diameter  is 
larger.  The  forehead  is  more  prominent.  The  eyes  are  a  little 
farther  apart.  The  nose  is  about  the  same  length.  While  there 
is  a  general  resemblance  about  the  mouth  and  chin,  the  distance 
from  the  front  of  the  chin  to  the  tip  of  the  nose  is  not  quite  as 
long.  In  this  the  shortening  of  the  chin  has  played  apparently 
the  chief  part.  In  the  third  generation  (Fig.  29)  the  forehead 
is  broader  and  less  retreating  than  in  the  second.  There  is  less 
prognathism  and  less  prominence  in  the  supra-orbital  region. 
In  the  fourth  generation  (Fig.  30)  appears  a  brachycephalic  type 
of  head.     It  is  nearly  round.    The  forehead  is  full.    The  eyes  are 


ENVIRONMENT,    CLIMATE,    SOIL    AND    FOOD, 


105 


set  in  the  head  to  correspond  with  its  width.  The  nose  is  broad. 
The  upper  Hp  is  short.  The  lower  jaw  is  much  broader  than  in 
the  first  generation  and  is  evidently  shorter  in  a  perpendicular 
line.  These  changes  result  from  the  formation  of  a  protruding 
forehead,  receding  chin  and  delicate  features. 

In  the  influence  of  climate  must,  however,  be  taken  into 
account,  as  already  stated,  modes  of  life.  The  distinction  once 
made  by  anthropologists  between  tropic  and  non-tropic  races  is 
no  longer  tenable  in  a  rigid  sense.  Experience  of  the  British 
in   India  and  of  the   Hollanders  in   lava  has  shown  that  with 


Fig.  29. 


Fig.  .30. 


change  of  habits  and  food  suited  to  the  environment,^  Europeans 
may  not  only  live  in  the  tropics  with  impunity  but  may  improve 
under  the  advantages  these  have  over  sub-arctic  and  temperate 
zones. 

These  possibilities  are  the  consequence  of  sound  sanitation. 
"The  fairest  laurel  practical  hygiene  may  boast  of  to-day  is 
doubtless  the  laurel  acquired,"  Gihon'^  truthfully  remarks,  "in 
ameliorating  the  sanitary  conditions  of  the  Europeans  in  tropical 
climates."     It  proves  the  truth  uttered  a  century  ago  by  James 

®  Degeneracy,  Op.  Cit. 
"^  Sajous  Annual,  1892. 


106  IRREGULARITIES    OF    THE    TEETH. 

Lind,  "much  more  than  to  the  climate,  you  are  indebted  to  your 
own  ignorance  and  neghgence  for  the  disease  from  which  you 
suffer  in  tropical  climates." 

Modern  researches  not  entirely  supporting  the  Hippocratian 
declaration,  tend  to  show  that  the  vital  resistance  of  the  different 
races  in  tropical  climates  depend  more  on  external  conditions 
than  on  race.  Acclimatibility  of  strong,  healthy  adult  Europeans 
of  both  sexes  in  tropical  climates  must  be  admitted  without 
reserve,  provided  that  they  assiduously  observe  hygienic  rules. 
Stokvis  has  disproved  the  allegation  that  the  European  is  not 
able  to  produce  in  tropical  regions  more  than  three  or  four 
generations  of  true  European  blood,  and  that  from  the  third  or 
fourth  generation  onward  sterility  is  the  rule.  With  the  perma- 
nent establishment  of  an  American  colony  in  the  Philippines 
these  facts  will  be  re-enunciated. 

Among  important  factors  to  be  considered  in  connection 
with  hygiene  in  the  tropics  are  the  questions  of  dietetics  as  well 
as  the  effects  of  moist  and  dry  heat.  The  two  last  produce,  as 
elsewhere  shown,  a  neurasthenia  with  co-existing  and  complicat- 
ing auto-intoxication.  These^  two  would  peculiarly  affect  the 
alveolar  process.^  It  is,  therefore,  not  remarkable  to  find  in 
a  recent  report  by  General  Otis,  the  case  of  Walter  Fitzgerald, 
Company  C,  twenty-eighth  infantry,  formerly  of  the  Montana 
volunteers,  cited.  This  twenty-three  year  old  man  has  been 
in  the  Philippines  for  a  year  and  seven  months.  He  was  one  of 
the  first  volunteers  to  reach  Manila  after  the  naval  battle.  Nine- 
teen months'  life  in  the  tropics  on  the  usual  army  rations  has 
resulted  in  the  loss  of  nearly  every  tooth.  While  the  climate 
undermines  nutrition  of  the  alveolar  process,  and  tropical 
fevers  have  the  same  effect,  improper  diet  increases  the  defect. 
In  the  case  of  Fitzgerald,  the  teeth  dropped  out  one  by  one,  as 
is  commonly  the  case  with  Americans  in  the  Philippines. 

The  English  speaking  race,  albeit  it  is  peculiarly  representa- 
tive of  the  upper  temperate  races,  has  shown  itself  able  to  endure 
all  climates.     The  type  now  forming  in  South  Africa  and  Aus- 

*  Inter.stitial  Gingivitis :  Transactions,  Section  on  Stomatology,  Amer- 
ican Medical  Association,  1900,  page  127. 
^  See  Interstitial  Gingivitis. 


ENVIRONMENT,    CLIMATE,    SOIL    AND    FOOD.  107 

tralia  recalls  the  early  New  England  and  Kentucky  type  of  the 
1 8th  century,  but  will  doubtless  pass  like  it  into  a  type  resem- 
bling that  of  the  fourth  generation  illustrated.  This  race  has  in 
its  own  home  been  peculiarly  mixed.  In  its  colonies  it  is  still 
more  so,  but  despite  this,  preserves  relatively  permanent  mental 
and  physical  racial  characteristics.  The  struggle  to  maintain  the 
mental  state  produces  the  variations  in  the  teeth  and  jaws  notice- 
ably present  in  the  English  speaking  races.  The  Scandinavian 
nations,  who  resemble  them  in  racial  admixture  and  adaptability 
to  climate,  have  the  same  tendencies. 

That  climate  does  not  exert  the  influence  once  claimed  for  it 
is  singularly  well  shown  in  Minnesota,  where,  thirty  years  ago, 
government  authorities  claimed  it  was  impossible  for  human 
beings  to  live  the  whole  year  owing  to  extreme  cold  in  winter. 
Now  not  only  is  the  soil  cultivated  throughout  the  entire  state, 
but  still  further  north  in  Manitoba  a  large  city  has  sprung  up 
surrounded  by  a  very  considerable  farming  population.  The 
influence  of  climate,  therefore,  can  be  guarded  against  by  man 
much  more  than  any  factor  of  his  environment. 

The  influence  of  altitude  on  the  physiologic  characteristics, 
while  very  obvious  at  times,  is,  however,  frequently  absent. 
While  as  a  rule  residents  at  high  altitude  are  strong,  robust, 
buoyant  and  of  great  mental  and  physical  endurance,  there  are 
numerous  exceptions. 

Hafner,^*^  of  Zurich,  has  recently  shown  that  "the  engineers 
and  workmen  on  the  Jungfrau  railway  obliged  to  remain  a  con- 
siderable time  at  altitudes  of  about  2,600  meters  above  the  sea 
level  are  liable  to  a  disagreeable  complaint.  After  eight  or  ten 
days  they  are  seized  with  violent  pains  in  several  teeth  on  one 
side  of  the  jaw,  the  gums  and  cheek  on  the  same  side  becoming 
swollen.  The  teeth  are  very  sensitive  to  pressure,  so  that  masti- 
cation is  extremely  painful.  These  symptoms  increase  in  sever- 
ity for  three  days  and  then  gradually  and  entirely  disappear.  It 
seems  to  be  purely  a  phenomenon  of  acclimatization.  All  new- 
comers pass  through  the  experience  and  the  disorder  never 
recurs."  The  influence  of  heat,  of  cold  and  of  the  barometric 
pressure  shown  in  a  lesser  degree  in  "mountain  fever"  produce 

10  Die  Natur,  1900. 


108  IRREGULARITIES    OF    THE    TEETH. 

systemic  disturbance  of  metabolism  which,  causing-  auto-intoxi- 
cation, markedly  affect  the  alveolar  process,  producing  inter- 
stitial gingivitis. 

The  effects  of  soil  upon  bone  growth  are  best  illustrated  in 
those  associated  with  goitre  and  cretinism.  Researches  among 
Indians  on  reservations  tend  to  show  the  influence  of  high  alti- 
tudes ;  climate  or  water  containing  excess  of  calcium-magnesium 
salts,  has  been  over-estimated.  Among  the  Indians  unsanitary 
surroundings,  depressing  constitutional  conditions,  improper  and 
excessively  nitrogenous  diet,  largely  produce  goitre  and  bone 
changes  often  associated  with  it. 

The  influence  of  food  in  producing  systemic  changes  which 
involve  interference  with  proper  osseous  development  may  be 
divided  into  two  factors.  One  involves  the  quality  of  the  food 
and  the  other  its  quantity  and  variety.  One  very  emphatic  illus- 
tration of  the  first  factor  is  the  constitutional,  skin,  nervous  and 
mental  disorder  known  as  pellagra.  This  condition  has  received 
much  attention  from  French  and  Italian  physicians.  While 
unhygienic  surroundings  play  a  part,  pellagra^i  is  chiefly  due  to 
spoiled  maize  taken  as  a  food.  The  frequency  with  which  jaw 
and  teeth  stigmata  are  found  with  pellagra  demonstrates  how 
potent  is  this  factor  of  improper  diet.  Monotony  of  diet  is 
likewise  a  very  emphatic  cause  of  constitutional  nervous  dis- 
order, such  as  distort  osseous  development.  Monotony  of  diet, 
as  I  have  elsewhere  shown,^-  aggravated  by  monotony  of  sur- 
roundings, has  undoubtedly  produced  a  large  amount  of  degen- 
eracy in  the  families  of  pioneers  in  the  United  States  and  of 
farmers  in  secluded  valleys  in  Norway,  Switzerland  and  else- 
where. Ray,  Brigham  of  New  York,  Awl  of  Ohio,  Patterson 
of  Illinois,  and  H.  M.  Stearns  of  Connecticut,  have  shown  that 
there  is  an  unusual  quantity  of  insanity  in  farmer's  wives  trace- 
able to  these  conditions.  A  case  reported  by  Kiernan,  of  Chi- 
cago, is  typical  of  those  earlier  described  by  the  American 
alienists  just  cited.  The  first  generation  was  a  woman  of  New 
England  stock,  of  tireless  energy,  to  whom  work  was  a  pleasure 
and  rest  an  abhorrence  and  who  lived  on  a  farm  miles  from  the 

"Billed  Pellagra. 

12  Degeneracy,   Op.  Cit. 


ENVIRONMENT,     CM  M  A  TK,     SOU,    AND    FOOD.  109 

town.  She  did  all  her  own  work  and  brought  up  a  large  family, 
chiefly  on  maize,  potatoes  and  bread,  pork  being  the  meat  diet. 
At  fifty  this  woman  removed  with  her  husband,  who  had  grown 
wealthy,  to  a  small  country  town.  Here  she  conducted  the 
entire  work  of  the  household  without  a  servant.  At  fifty-two 
she  broke  down  with  neurasthenia,  which  rapidly  passed  into 
periodical  gloomy  spells,  in  one  of  which  she  committed  suicide. 
Her  youngest  daughter,  who  had  an  asymmetrical  face,  has  the 
periodical  gloomy  tendency  of  the  mother  alternating  with 
periods  of  restlessness,  which  evince  themselves  in  doing  unnec- 
essarily the  work  of  the  servants  and  other  labors  inconsistent 
with  her  huband's  social  status.  She  had  at  times  suicidal  and 
homicidal  impulses.  She  has  three  children;  one  exhibits  no 
special  abnormality ;  the  eldest,  a  boy  of  eleven,  dislikes  to  play 
with  boys  because  they  are  rough,  plays  with  girls,  to  whom  he 
is  at  times  mischievously  cruel.  He  likes  to  sew  doll's 
clothing  and  purchase  dolls,  while  there  are  other  indications  of 
sexual  abnormality.  The  youngest,  a  girl,  has  frequent  attacks 
of  epileptic-like  fury,  although  between  these  she  is  kind-hearted, 
good  humored  and  very  affectionate. 

The  fungus  on  maize  (ustilago)  like  the  fungus  on  rye  (ergot) 
produces  rather  long  lasting  neuroses  of  epileptic  character, 
susceptible  of  transmission  to  the  offspring  of  women  poisoned 
by  the  fungi. 

The  influence  of  vegetarian  diet  seems  to  be  deteriorating 
to  the  races  who  are  restricted  to  it  alone.  These  races  are 
usually  cowardly,  meanly  cruel,  extremely  mendacious,  untrust- 
worthy, weak  in  stamina  and  readily  yield  to  morbid  influences. 

The  influence  of  potato  diet  in  degenerating  the  Irish  Celt 
in  comparison  with  the  Scottish  Celt  under  the  same  conditions 
is  difficult  at  present  to  determine  for  lack  of  data.  Certainly 
the  descendants  of  this  class  of  Irish  Celts  rapidly  regain  a 
handsome,  healthy  status  under  mixed  American  diet,  even 
though  the  hygienic  surroundings  in  the  great  cities  be  not  the 
best.  He  who  has  to  treat  a  class  of  neurasthenics  in  whom 
starch  digestion  is  impaired  finds  that  a  diet  of  potatoes 
(undoubtedly  through  the  auto-intoxication  it  produces)  will 
increase  certain  nervous  symptoms  and  hence  the  tendency  to 


110  IRREGULARITIES    OF    THE    TEETH. 

transmission  to  the  next  generation.  The  widespread  influence 
of  nutrition  is  excellently  illustrated  in  the  conditions  produced 
in  children  and  in  the  insane,  by  improper  food  and  the  reaction 
of  these  to  hygienic  diet.  Improper  diet  in  the  child  may,  as 
Christopher^^  j^^s  shown,  produce  all  possible  nervous  disorders, 
including  those  involving  the  trophic  processes.  This  is  pecul- 
iarly evident  in  scurvy  and  rickets  and  their  effects  on  the  general 
osseous  development.  Improper  maternal  diet  during  preg- 
nancy may,  as  Elise  Berwig^"*  has  shown,  produce  similar  effects. 

The  influence  of  the  maternal  environment  upon  the  foetus 
has  been  much  underrated  because  of  the  belief  that  the  placenta, 
by  its  filtering  and  poison-destroying  function,  protected  the 
foetus.  That  this  was  an  error  in  many  respects  has  been 
already  shown  by  the  arrests  of  development  produced  by  the 
toxines  of  the  great  contagions.  It,  however,  justified  for  a 
time  hazardous  occupations  for  pregnant  women.  Later  investi- 
gation showed  that  not  only  did  organic  poisons,  like  opium, 
pass  through  the  placenta,  but  that  mineral  poisons,  like  lead, 
did  also.  Calkins,^  ^  nearly  four  decades  ago,  pointed  out  that 
the  children  of  opium-using  mothers  died  in  the  first  months 
after  birth  unless  given  opium.  Bureau  later  showed  that  in 
such  cases  the  umbilical  cord  contained  large  quantities  of  mor- 
phine. 

Many  years  ago  it  was  known  that  the  children  of  the  work- 
ers in  tobacco  factories  exhibited  very  little  vitality  and  much 
deformity .i**  As  tobacco  is  a  government  monopoly  in  France 
an  attempt  was  made  to  destroy  this  opinion  by  a  cooked  report 
from  the  Imperial  authorities.  The  evidence,  however,  from 
other  sources  contradicted  this  report  and  the  latest  investiga- 
tions in  France  (those  of  Etienne^'^)  strongly  support  previous 
opinion  that  maternal  work  in  tobacco  factories  is,  as  I  have 
elsewhere  shown,^^  the  cause  of  frequent  miscarriage,  of  high 
infantile  mortality,  of  defective  children  and  of  infantile  convul- 

^3  Cited  in  Degeneracy,  Op.  Cit. 

1*  Medicine,  1898. 

IB  The  Opium  Habit. 

1'  Annual  of  the  Universal  Medical  Sciences,  1892. 

1' British  Medical  Journal,  April  23,  1898. 

18  Degeneracy,  Op.  Cit. 


ENVIRONMENT,     CLIMATE,     SOU,    AND     FOOD.  Ill 

sions.     The   influence   of   mineral   poisons   has   been   carefully 
studied  by  Porak,i"  who  has  found  that  lead  and  phosphorus 
pass  through  the  placenta  and  enter  the  child's  circulation.    Lead, 
as  I   have  elsewhere  pointed  out,  has  been  found  to  produce 
in   those   exposed   to   its   fumes   systemic   nervous   exhaustion, 
characterized  by  local  paralysis  about  the  wrist  as  well,  as  the 
general  symptoms  of  profound  systemic  nerve  tire.     This  may 
result,  as  Tanquerel   des   Planches^o  pointed  out  nearly  half  a 
century  ago,  in  acute  insanity  of  the  confusional  type  followed 
very  often  by  forms  of  mental  disorder  of  a  chronic  type  resem- 
bling paretic   dementia.      In   some   cases   the   patient    recovers 
from  the  acute  insanity  to  suffer  thereafter  from  epilepsy.     In 
other  cases,  as  Kiernan  has  shown,2i  an  irritable  suspicional  con- 
dition results  in  which  the   patient  may  live  for  years,  marry 
and  leave  offspring.    This  last  condition  and  the  epileptic  are  the 
most  dangerous  as  to  the  production  of  degeneracy.    As  already 
pointed  out,22  the  women  employed  in  the  pottery  factories  in 
Germany  sufTer,  according  to  Rennert,-^   from  a  form  of  lead 
poisoning  which  produces  decidedly  degenerative  effects  upon 
the    offspring.      These    women    had    frequent    abortions,    often 
produced   deaf-mutes    and   very  frequently   macrocephalic  chil- 
dren.    On  investigation  of  the  Staffordshire  potteries,^'*  similar 
conditions  have  been  observed.    Kiernan^^  has  reported  the  case 
of  a  macrocephalic  idiot  born  of  a  mother  who  had  lead  poison- 
ing while  a  worker  in  a  Staffordshire  pottery.     Brass  workers, 
as  I  have  pointed  out  some  years  ago,  suffer  from  a  very  similar 
condition  to  that  produced  by  lead.    Hogden,^^  of  Birmingham, 
over  half  a  decade  ago,   called  attention  to   the   grave  forms 
of  nervous  exhaustion  produced  among  brass  workers.     His 
results  have  since  been  confirmed  by  German  and  other  observ- 
ers.^^     The  period  during  which  the  patient  is  able  to  pursue 

1^  University  Medical  Magazine,  1895. 

20  Lead  Diseases,  American  Edition,  1848. 

21  Journal  of  Nervous   and   Mental   Diseases,   1881. 
"-  Degeneracy,  Op.  Cit. 

23  American  Journal  of  Obstetrics,  18B2. 
-*  British  Medical  Journal,  August,  1900. 
25  Obstetrics,  Feb.,  1900. 
-^  Birmingham  Medical  Review,  Jan.,  1887. 
27  Medicine,  1901. 


112  IRREGULARITIES    OF    THE    TEETH. 

his  occupation  without  breaking  down  is  longer  than  that  of  the 
lead  workers.  Women,  like  men,  are  exposed  to  this  condition. 
The  chief  efit'ect  produced  so  far  as  offspring  has  been  observed 
are  frequent  abortions  and  infantile  paralysis. 

The  occupations  employing  mercury  (whether  mining,  mirror 
making  or  gilding)  produce  systemic  nervous  exhaustion  in 
which  the  most  marked  symptoms  (but  less  important  from  a 
sanitary  standpoint)  is  a  tremor  amounting  at  times  to  shaking- 
palsy.  Like  all  other  systemic  nervous  exhaustion,  the  mercurial 
one  may  appear  as  degeneracy  in  the  offspring.  The  employ- 
ment of  women  in  match  factories  and  tenement  house  sweating 
shops  is  growing.  The  chief  toxic  effects  of  phosphorus  is 
not  the  localized  jaw  neurosis.  This  is  but  an  evidence  of  the 
progressive  system  saturation  with  phosphorus.  It  bears  the 
same  relation  to  the  more  dangerous  effects  of  phosphorus  that 
"blue  gum"  does  to  the  systemic  effects  of  lead.^s 

Workers  in  carbon  bisulphide  have  been  noted  to  suffer  from 
the  initial  stages  of  interstitial  gingivitis.  Lazarus^^  has  recently 
reported  the  cases  of  twenty  young  women  employed  in  rubber 
factories  who  exhibited  a  necrotic  process  in  the  jaws  and  teeth 
similar  to  that  resultant  on  phosphorus. 

28  Degeneracy,  Op.  Cit. 

29  Allg.  Med.  Cent.  Ztg.,  Dec.  22,  1900. 


CHAPTER  XIII. 


RACE    AD?^IIXTURE. 

Race  admixture  has  l)een  greatly  underestiinatcd.  Etliuic 
researches  of  the  past  decade  have  thrown  much  doubt  t)n  the 
standards  set  up  as  race  tests. 

It  is  usually  assumed  a  clear  distinction  can  be  made  on  philo- 
k)gic  grounds  between  different  races,  and  even  Aryan  races  can 
be  easily  separated.  This,  however,  ethnology  has  shown  to  be  an 
error.  The  following  table,  modified  from  Keane,  demonstrates 
that  speech  is  no  test  of  race  : 


Peoples. 

Ethnic  Group. 

Linguistic 

Family 

English    and   Lowland 

Kelto-Teutonic 

Teuton  io 

Scotch. 

Cornish 

Silure-Kelto-Teutonic 

Teutonic 

Welsh 

Silure-Kel  to-Teutonic 

PCeltic 

Scotch   (Highland) 

Silure-Kelto-Teutonic 

Keltic 

Irish    (West) 

Silure-Kelto-Teutonic 

Keltic 

French 

Ibero-Kelto-Teutonic 

Italic 

Spaniards 

Teuto-Ibero-Keltic 

Italic 

Germans 

Slavo- Kelto-Teutonic 

Teutonic 

Bohemians 

Kelto-Teuto-Slavonic 

Slavonic 

Russians  (many) 

Finno-Slavonic 

Slavonic 

Fins  (manjO 

Teuto-Slavo-Finnic 

Teutonic 

Bulgarians 

Ugro-SIavonic 

Slavonic 

Hungarians  (Magyars) 

Ugro-Teuto-Slavonic 

Finnic 

Prussians  (East) 

Letto-Teuto-SIavonic 

Teutonic 

Roumanians 

Italo-Slavo-Illyric 

Italic 

Italians 

Teuto-Liguro-Kelto- 
Italic 

Italic 

Profoundly  mixed  as  this  table  indicates  European  races  to  be, 
it  is  far  from  representing,  as  I  have  elsewhere^  shown,  the  full 
extent  of  race  mingling.  The  primitive  worship  of  the  Slavonic 
Czernebog  by  the  Saxons  in  England  demonstrates  a  Slavonic 
strain  derivable,  as  Kiernan  suggests,  from  their  contact  with 
the  W'ends  of  the  Baltic.  Xot  merely  are  the  Aryan  races  of 
Europe  mixed  together,  but  the  blood  of  all  has  a  pre-Aryan 

1  Degeneracy,  Op.  Git. 

9  113 


lit  IRREGULARITIES    OF    THE    TEETH. 

and  a  Turanian  dash.  As  Taylor,-  Windle-"  and  others  have 
shown,  the  Iberian  type  is  found  in  Wales  and  Scotland  as  well 
as  elsewhere,  though  in  lesser  degree.  These  admixtures  date 
back  to  palaeolithic  times  when,  although  the  predominant  type 
of  skull  was  dolichocephalic  (or  long-headed),  the  brachycephalic 
(or  round-headed  type)  had  begun  to  appear  in  America,  then 
connected  by  land  with  both  Africa  and  Europe.  In  subsequent 
neolithic  times,  while  the  type  is  at  first  generally  brachycephalic, 
it  soon  becomes  mesocephalic  (mixed  long  and  round-headed), 
pure  brachycephalic  and  dolichocephalic   becoming  rare. 

As  Starr-*  admits,  even  the  race  type  called  the  American 
Indian  still  so  retains  traces  of  the  race  elements  forming  it  in  the 
pleistocene  period  that  these  elements  are  yet  distinguishable 
by  ethnologists.  In  nose  types  the  American  Indian  race  leans 
toward  its  proto-caucasic  rather  than  its  proto-mongolic  or 
proto-negroid  elements. 

Three  types  appear  in  Great  Britain  and  Ireland  and  traces 
of  their  blood  are  still  detectable  in  living  men.  Sir  Walter 
Scott  draws  an  excellent  picture  of  one  in  "Rob  Roy,"  whose 
hero,  according  to  reliable  tradition,  presented  the  Pict  type. 
Gomme^  has  shown  these  races  persisted  long  enough  to  stamp 
their  savage  beliefs  on  coming  races  and  intermingled  with  them. 
The  Neolithic  race  in  Great  Britain  was  dark,  of  feeble  build, 
short  stature,  with  dolichocephalic  skulls.  This  race  remained  to 
the  historic  period  as  the  Silures  in  Great  Britain  and  the  Fir- 
bolgs  in  Ireland.  It  had  high  cheek  bones  and  oblique  eyes, 
as  Kiernan^  points  out.  Towards  the  middle  of  the  neolithic 
period  this  race  "was  conquered  by  a  brachycephalic,  tall,  long- 
armed,  muscular  race,  with  florid  complexion  and  yellowish  or 
red  hair.  Scott's  "Rob  Roy"  is  an  example  of  this  type.  A 
third  race  of  fair  complexion  with  prognathous  jaws,  dolicho- 
cephalic skulls,  of  tall  stature,  great  bones,  great  chest  develop- 
ment and  massive  jaws,  later  invaded  Great  Britain. 

As  the  intermingling  of  races  began  early,  the  question  of 

2  Origin  of  the  Aryans. 

3  Life  in  Early  Britain. 

4  Journal  of  the  American  Medical  Association,  Dec.  15,  1900,  p.  1575. 
^  Ethnology  in  Folklore. 

6  Alienist  and  Neurologist,  1891. 


RACE    ADMIXTURE.  115 

the  existence  of  pure  races  to-day,  or  even  during  the  historic 
period,  is  an  open  one.  The  Hebrews  have  been  comparatively 
pure  since  the  return  from  captivity.  Before  that,  as  the  history 
of  Solomon's  foreign  marriages  demonstrates,  they  were,  as 
Laing  shows,  a  raceless  chaos,  the  Semitic  element  predominat- 
ing." Researches  by  Flinders  Petrie  and  others  indicate  that  the 
Copts  or  ancient  Egyptians  were  a  mixture  of  Turanians,  Ham- 
ites,  Aryan  and  Semite  peoples  imposed  on  a  negroid  basis. 
When  these  elements  were  finally  fused,  the  race  bred  relatively 
true,  although  the  lower  classes  tended  to  the  negroid  type  and 
the  higher  to  the  Caticastic. 

The  Coreans  are  a  mixture  of  two  primitive  races,  one  white 
and  one  yellow.  The  Japanese,  whose  ancestors  emigrated  to 
Japan  from  Corea,  are,  according  to  Topinard,^  the  product 
of  the  addition  of  three  distinct  types  to  that  forming  their 
Corean  ancestors.  The  Caucasic,  to  a  small  extent,  The  Poly- 
nesian to  a  greater,  and  the  Malay  to  a  still  greater,  are  mixed 
with  the  original  Corean. 

The  Chinese  are  neither  a  homogenous  people  nor  a  pure 
race,  albeit  the  relatively  few  Mantchus  are  dominant.  The 
Aryan  of  India,  on  whom  Max  Muller  laid  such  stress,  is  known 
to  be,  despite  a  rigid  caste  system,  a  non-Aryan  race,  feebly 
infused  with  a  modicum  of  Aryan  blood.  The  so-called  "Gypsy" 
seems  of  all  the  races  of  India  to  have  retained  most  xA.ryan 
speech  and  type  as  well  as  original  Aryan  semi-nomadic 
wagon-journeying  in  the  midst  of  settled  civilization.  Ghetto 
seclusion  long  helped  to  preserve  relative  purity  of  race  in  the 
Jew,  but  despite  vagabond  surroundings  the  "Gypsy"  has 
remained  even  purer. 

Great  as  has  been  the  mixture  of  even  widely  separated  types 
like  three  races  described  as  mingling  in  Great  Britain  and  Ire- 
land, even  greater  admixture  occurred  in  comparatively  late  his- 
toric times.  The  so-called  Scotch-Irish  (whose  blood  enters  so 
largely  in  the  dominant  race  of  the  United  States),  despite  their 
speech  (much  more  Teutonic  and  monosyllabic  than  English)  are, 
asKiernan  has  shown,  a  raceless  chaos  of  Gaelic  and  Cymric  Celts, 


"^  Human  Origins. 
8  Anthropology. 


116  IRREGULARITIES    OF    THE    TEETH. 

Lowland  Scotch,  French  Huguenots,  Danes  (Celto-Teuto-Slaves), 
Palatinate  Germans,  Magyars,  English  Puritans,  Hollanders, 
Swedes,  Protestant  Italians,  Poles  and  Spaniards.  The  inter- 
mixture of  the  dark,  small-boned  dolichocephalic,  orthognathous 
(with  in-drawn  jaws)  race  with  the  brachy cephalic,  prognathous, 
big-boned,  red-haired,  and  then  with  dolichocephalic,  progna- 
thous, deep-chested,  big-boned  fair  race,  produced  in  the  British 
Isles  as  marked  variations  in  type  as  now  occur  from  the  admix- 
ture of  the  Indian  and  the  Negro.  While  religion  played  a  part 
in  these  admixtures  in  the  British  Isles,  war,  commerce  and 
art  also  exerted  an  influence.  Bunyan,  the  author  of  the  "Pil- 
grim's Progress,"  was  the  descendant  of  Bunyano,^  an  Italian 
architect,  imported  to  build  Melrose  Abbey.  The  destruction 
of  the  Spanish  Armada  introduced  Spanish  elements  all  along 
the  West  and  East  coasts  of, England,  Ireland  and  Scotland. 
The  capture  of  Calais  by  the  French  from  Mary  Tudor  added 
a  French  colony  to  London. 

In  Scandinavia  (Denmark,  Norway  and  Sweden),  race  admix- 
tures, although  less  discussed,  are  as  great  as  those  in  the  British 
Isles.  The  primitive  race  called  the  Quens  was  of  Eskimo  type. 
This  race  was  first  intermixed  with  a  tall,  long-armed,  brachy- 
cephalic,  muscular  race  with  florid  complexion  and  yellowish 
or  red  hair.  The  race  resultant  on  this  mixture  was  later  fused 
»with  a  third  having  prognathic  jaws,  large  dolichocephalic  skulls, 
tall  stature,  great  bones,  great  chest  development  but  small 
hands  and  high  arched  feet.  After  these  race  admixtures  had 
formed  the  Scandinavians,  who  became  the  sea  kings,  the  inter- 
mixture with  other  races  still  continued.  Around  Bergen,  Nor- 
way, was,  as  Mantegazza^^  points  out,  an  Irish  colony  with  well- 
formed,  delicate  features,  brunette  complexion,  oblique  blue 
eyes  and  black  hair.  The  influence  of  this  colony  is  still  so 
demonstrable  as  to  be  frequently  used  in  fiction  by  writers  like 
Bjornson.ii  As  there  were  dilYerent  types  of  skull  and  face 
among  the  races  making  up  the  English-speaking  and  Scandi- 
navian-speaking peoples,  the  contest  for  existence  (between  the 


^  Notes  and  Queries,  it 
1"  Physiognomy. 
11  "In  God's  Ways." 


RACE    ADMIXTURE.  117 

organs  of  man)  centered  itself  with  peculiar  intensity  on  struct- 
ures which,  like  the  jaws  and  teeth,  are  so  variable  with  a  rise 
in  the  scale  of  evolution.  The  scion  of  an  orthognathic  mother 
and  prognathic  father  would  have  marked  irregularity  of  the 
jaws  and  teeth  destitute  of  the  significance  of  the  depth  of  degen- 
eracy implied  by  the  same  irregularities  in  a  purely  prognathic 
or  orthognathic  race.  Food  which  exacted  less  active  functions 
on  the  part  of  the  jaws  and  teeth  in  such  a  mixed  race  would 
imply  an  intense  struggle  for  existence  between  the  different 
teeth  and  this  struggle  and  would  proceed  with  greater  or  lesser 
intensity  as  the  organism  was  or  was  not  afifected  by  that  con- 
stitutional nerve  strain,  which  precedes  general  degeneracy.  The 
different  factors  afifecting  the  constitution  of  the  ancestor  create, 
as  has  been  shown  already,  a  general  loss  of  nerve  tone,  which 
reheves  the  local  nerve  systems  of  control  by  the  central  nerve 
system.  These  local  nerve  systems  take  on  a  feverish  activity 
in  consequence  and  become  themselves  exhausted.  In  propor- 
tion, therefore,  as  the  general  nervous  system  has  control  would 
the  evolution  of  the  teeth  and  jaws,  in  their  relation  to  the  organ 
struggle  for  existence,  proceed  with  regularity. 

The  influence  of  food,  while  beneficial  to  the  organism  as  a 
whole,  may,  as  already  pointed  out,  introduce  a  struggle  for 
existence  between  the  teeth,  which  would  cause  local  degenera- 
tions of  these  and  the  jaws.  Even  in  man,  employment  of  the 
teeth  and  jaws  as  a  weapon  of  ofifense  and  defense  would  prevent 
that  degeneracy  as  a  jaw  otherwise  consequent  upon  decreased 
use  resultant  on  a  change  from  vegetable  and  nut  diet  to  the 
more  easily  digested  and  masticated  meat  or  fish  diet.  The  per- 
sistence of  prognathism  in  races  as  high  as  those  described  even 
when  brachycephalic  is  an  indication  that  the  use  of  the  jaw 
for  a  weapon  interfered  with  its  degeneracy  consequent  on  im- 
proved food.  It  may  be  admitted  that  man  was  a  vegetable 
feeder  originally,  but,  as  shown  by  the  atrophic  tendency  of  the 
vermiform  appendix,  he  early  became  a  user  of  animal  food, 
albeit  not  to  the  extent  of  the  carnivorous  mammals  in  whom 
the  appendix  has  disappeared.  This  change,  however,  early 
initiated  a  tendency  to  variability  in  the  jaws  and  teeth. 

This  variability  is  excellently  shown  in  the  following  illus-. 


1]8 


IRREGULARITIES    OF    THE    TEETH. 


trations,  of  four  generations  of  so-called  "Anglo-Saxon"  Ameri- 
cans of  the  Knickerbocker  type  : 

Fig.  31.  Here  is  seen  a  probably  Neolithic  Hollander  type 
with  low  receding  negroid  forehead,  small  sunken  eyes,  protrud- 
ing nose  and  upper  jaw,  short  upper  lip,  cheek  bones  prominent, 
receding  lower  jaw. 

Fig.  32.  This  subject  was  born  of  the  previous  type,  settled 
in  New  York.  The  change  in  climate  has  altered  the  face  con- 
siderably.    The  forehead  is  higher,  broader,  and  more  promi- 


Fig.  .3-^ 


ncnt.  The  eyes  are  large  and  not  so  deeply  set.  The  cheek 
bones  are  not  so  prominent,  nose  and  upper  jaw  less  prom- 
inent, upper  lip  longer,  chin  the  same. 

Fig.  33.  Admixture  of  race  types  has  produced  a  forehead 
broad  and  full,  eyes  less  sunken,  recession  of  cheek  bones,  nose 
and  upper  jaw  ;  upper  lip  same;  lower  jaw  broader,  anterior  posi- 
tion same. 

Fig.  34.  Here  the  forehead  is  still  broader,  more  prominent, 
higher ;  large,  round  eyes.  There  is  more  recession  of  the  cheek 
bones.  The  nose  and  upper  jaw  are  the  same.  The  face  broader, 
lower  jaw  broader  and  anterior  position  same. 


RACE     ADMIXTURE. 


110 


This  variability  is  an  expression  of  the  law  of  economy  of 
growth  whereby  an  organ  under  the  influences  of  the  struggle  for 
existence,  degenerates  from  the  ideal  type  of  the  organ  as  an 
organ  for  the  benefit  of  the  organism  as  a  whole.  This  variabil- 
ity along  local  lines  of  degeneracy  has,  as  De  Moor^-  shows, 
peculiarly  taken  the  line  of  least  resistance  in  the  jaws  and 
teeth. 


Fig.  33. 


Fig.  34. 


The  tendency  in  race  admixture  (when  the  new  blood  is  of 
stocks  with  large  jaws  and  regular  teeth)  is  to  stamp  out  local 
influences  which  tend  to  produce  arrest  of  development  and 
irregular  teeth.  By  constant  race  admixture  the  jaws  retain 
their  normal  regular  shape.  The  tendency  of  the  child  to  inherit 
the  small  jaws  of  one  and  the  large  teeth  of  the  other  or  vice 
versa  is  a  fruitful  source  of  facial  and  jaw  deformity. 

^2  Evolution  by  Atrophy. 


CHAPTER  XIV. 


CONSTITUTIONAL    DISORDERS. 

The  influence  of  constitutional  disorders  on  the  development 
of  the  skull  and  face  must  be  viewed  from  two  standpoints. 
First,  from  the  standpoint  of  the  mother  affected  during-  preg- 
nancy, and.  second,  from  the  standpoint  of  the  foetus  affected 
during  intra-uterine  life,  or  of  the  child  affected  precedent  to 
or  during  the  periods  of  stress.  The  influence  of  constitutional 
disorders,  especially  the  infections  upon  the  mother,  may,  as  I 
have  pointed  out  elsewhere,  result  in  the  bony  maldevelopment 
shown  to  occur  in  animals  by  Charrin  and  Gley,^  and  in  man  by 
Coolidge.  The  facial  bones,  jaws  and  teeth  are  peculiarly  liable 
to  this.  Though  the  effect  of  the  disease  on  the  parent  be  but 
temporary,  foetal  development  may  be  checked  as  to  higher  ten- 
dencies. Thus  mothers  have  borne  moral  imbeciles,  epileptics, 
lunatics  or  deformed  children  after  a  pregnancy  during  which 
they  were  attacked  by  contagious  disease.  The  children  of  sub- 
sequent and  previous  pregnancies  were  normal. 

The  children  of  pregnancies  previous  to  the  one  complicated 
by  the  contagious  disease  may  be  healthy,  while  those  of  subse- 
quent pregnancies  are  defective.  Any  contagious  or  infectious 
disease  may  not  only  interfere  temporarily  with  the  bodily 
strength,  but  may  produce  complete  change  in  the  parent's  sys- 
tem, extending  even  to  the  highest  acquirements  of  man.  In 
some  occur  changes  thus  graphically  described  by  Buhver  :^ 
"There  have  been  men  who,  after  an  illness  in  which  life  itself 
seemed  suspended,  have  arisen  as  out  of  a  sleep  with  characters 
wholly  changed.  Before,  gentle,  good  and  truthful,  they  now 
become  bitter,  malignant  and  false.  To  those  whom  they  before 
loved  they  evince  repugnance  and  loathing.  Sometimes  this 
change  is  so  marked  and  irrational  that  their  kindred  ascribe  it 
to  madness.  Not  the  madness  which  affects  them  in  the  ordinary 
business  of  life,  but  that  which  turns  into  harshness  and  discord 

^  Degeneracy,   op.   Cit. 

120 


CONSTITUTIONAL     DISORDERS.  121 

the  moral  harniony  which  rcsuUs  from  natures  whole  and  com- 
plete."2 

The  nerve  centers  controlling  nutrition,  growth,  repair,  secre- 
tion and  excretion  are  often  as  deeply  affected  as  those  checks 
constituting  morality.  At  the  periods  of  physiologic  .stress  these 
effects  are  especially  noticcahle.  Moral  insanity,  intellectual 
insanity,  unequal  mental  balance,  hysteria,  precocious  sexuality, 
unconscious  mendacity,  mental  parasitism  (the  germ  of  pauper- 
ism), epilepsy,  neuroses  and  all  types  of  nutritive  and  constitu- 
tional defects  result.  The  nutritional  defects  may  appear  chiefly 
in  the  walls  of  the  blood  vessels  and  lymphatics,  as  in  scurvy 
mercurial  poisoning.-^  etc.  While  these  are  most  common  in 
,  the  chronic  infections  and  contagions,  they  often  occur  in  acute, 
typhoid  fever,  scarlatina,  diphtheria,  whooping-cough,  etc. 
Proper  blood  supply  and  utilization  of  waste  is  thus  prevented. 
Organs  cannot  perform  their  function,  and  are  predisposed  to 
disease  from  disuse  and  from  w^eakness  of  the  disease-fighting 
phagocytes  and  antitoxins.  From  this  results  irregularity  of 
organ  function,  which  is  hereditarily  transmissible.  The  weak- 
ened vessel  walls  yield  to  strain,  and  thus  produce  local  stom- 
ach, bowel,  liver,  gland,  and  kidney  disorders.  This  organ  weak- 
ness may  alone  be  transmitted  to  the  offspring.  The  functions 
of  the  great  ductless  glands  (thyroid,  thymus,  adrenals,  pituitary 
body,  bone-marrow,  etc.)  which  secrete  principles  necessary  to  the 
equal  balance  of  nutrition,  are  perverted.  The  liver,  in  the  acute 
but  more  particularly  in  the  chronic  contagions,  paralyzed  in 
nerve  tone,  fails  in  its  functions,  nutritive  and  poison-destroying, 
as  for  the  same  reason  the  kidneys  fail  in  their  power  of  eject- 
ing hurtful  waste.  Through  this,  interaction  of  perverted  nutri- 
tion, imperfect' poison-destruction  and  deficient  waste  ejection 
result  and  continue  the  states  of  nervous  exhaustion  after  the 
contagions  and  infections.  Thus  nerve  exhaustion,  with  its 
suspicion,  its  capricious  hopefulness  and  gaiety,  is  practically 
continuous  in  tuberculosis,  syphilis  and  leprosy. 

The  influence  on  bony  and  dental  development  of  all  consti- 
tutional diseases  in  a  general  way  resembles  the  influence  of 

-  "A  Strange  Story." 
3  Interstitial  Gingivitis, 


122  IRREGULARITIES    OF    THE    TEETH. 

syphilis.  This  influence  is  exerted  in  two  ways.  First,  on  the 
individual,  which  may  affect  development  of  the  bones  or  teeth 
if  it  occur  during  the  periods  of  evolutionary  stress.  Syphilis 
contracted  during-  infancy  thus  affects  the  development  of  the 
teeth.  The  same  is  true  of  all  infectious  diseases  to  a  greater  or 
lesser  extent  and  is  also  true  of  conditions  like  scurvy  and  rick- 
ets. In  a  general  way  also  the  influence  is  of  the  contagious 
diseases  as  exerted  on  the  descendant  of  two  types.  Firstly, 
the  direct  transmission  of  the  disorder,  which  must  be  regarded 
as  intra-uterine  infection,  and,  secondly,  the  transmission  from 
the  ancestor  to  the  descendant  of  sundry  pathologic  characters 
having,  as  E.  Fournier*  remarks,  nothing  specific  per  se,  but  con- 
sisting perchance  in  native  inferiorities  of  constitution,  of  tem- 
perament, of  vital  resistance,  perchance  in  retardations,  arrests 
(Fig.  35)  or  imperfections  of  development,  mental,  physical  or 
manifested  in  organic  changes ;  either  malformations  of  organs 
or  monstrosities.  The  first  of  these  heredities  in  the  case  of 
syphilis  has  received  the  title  of  syphilitic  heredity,  properly 
so-called.  The  second  has  received  several  synonymous  titles ; 
parasyphilitic  heredity,  dystrophic  heredity,  or  toxinic  heredity. 
In  the  last  toxins  produced  by  germs  or  poisons  produced  by 
maternal  nutritional  defects  cause  the  arrests,  retardations, 
imperfections  of  development  seen  in  the  children  of  otherwise 
healthy  mothers  suffering  from  the  infections  and  contagions  or 
from  nutritional  disorders  or  defects  just  precedent  to,  or  during, 
the  period  of  pregnancy,  or,  during  the  period  of  lactation.  Dur- 
ing the  periods  of  stress,  moreover,  if  these  toxins  or  allied  sub- 
stances be  generated  in  the  individual  organs,  they  cause  the 
bony  and  dental  arrests,  retardations  and  imperfections  of  devel- 
opment so  frequently  noticed  after  scarlatina,  pneumonia,  cere- 
bro-spinal  meningitis,  etc.,  as  well  as  rickets  and  allied  condi- 
tions occurring  during  infancy  and  childhood. 

The  regenerative  process  in  all  tissues  is  below  par  in  consti- 
tutional diseases.  Hence  wounds  do  not  heal  as  readily  in  a 
person  the  subject  of  constitutional  disease.  The  development 
of  tissue  from  an  embryonal  type  to  mature  tissue  is  identical 
with  the  regenerative  process  in  the  healing  of  wounds.    There- 

*  Stigmates  Dystrophiques  de  I'Heredo-Syphilis, 


CONSTITUTIONAL     DISORDERS.  123 

fore,  the  causes  which  retard  the  one  process  must  retard  the 
other.  According  to  Mctschnikoff,  the  energy  of  the  organism 
is  expended  in  repelHng  the  advances  and  barring  the  further 
progress  of  the  micro-organisms  or  other  causes  of  constitutional 
diseases.  In  consequence  of  this  continuous  warfare  between 
the  ceHs  and  microbes  the  tissue  cells,  that  are  regenerated,  do 
not  increase  the  size  of  the  organs  as  in  normal  development. 


Fig.  So. 

Senile  Stres.s  Period  of  Intra-Uterine  Life: 
four  and  a  half  months. 

These  constitutional  diseases  cause  arrests  of  development,  which 
may  become  permanent  from  the  time  of  the  disease.  More 
often  the  growth  of  the  child  is  stopped  for  one  or  more  years, 
and  frequently  development  will  not  proceed  until  the  child  is 
taken  to  another  climate.  The  effect  upon  the  jaws  and  teeth 
is  very  marked,  especially  in  the  upper  jaw.  When  arrest  of 
development  of  the  teeth  takes  place,  frequently  pits  and  furrows 
are  found  upon  the  enamel.     By  these  pits  and  furrows,  the 


124  IRREGULARITIES    OF    THE    TEETH. 

exact  year  when  the  arrest  of  development  took  place  may  be 
determined.  Hutchinson's  teeth,  familiar  to  physicians,  dentists 
and  syphilographers,  are  striking  illustrations  of  this  fact. 

The  eruptive  fevers  in  children  have  a  tendency  to  leave  the 
system  in  a  neurotic  condition.  Children,  who  before  were 
apparently  healthy,  after  these  diseases  are  sickly  and  ailing  for 
years,  and  sometimes  they  never  wholly  recover.  Such  condi- 
tions affect  the  eyes  and  ears  and  not  infrequently  the  organs 
of  speech.  The  eyes  remain  weak,  occasionally  the  patient 
becomes  nearly  or  quite  blind.  The  hearing  is  frequently  perma- 
nently impaired ;  occasionally  the  nerve  centers,  which  preside 
over  the  development  of  the  osseous  system.  There  is  a  general 
arrest  of  development  of  the  whole  body.  Such  persons  not 
infrequently  remain  sickly,  neurotic  or  morally  imbecile.  While 
they  may  regain  health,  the  body  ceases  to  develop  normally. 

A  young  girl,  now  twenty,  born  of  apparently  healthy  parents, 
had  a  severe  attack  of  scarlet  fever  at  the  age  of  seven  years. 
Arrest  of  development  of  the  upper  jaw,  and  a  V-shaped  arch 
developed  ;  she  has  been  near-sighted  ever  since  and  now  has 
very  weak  eyes  ;  stopped  growing  for  three  years.  She  was  taken 
to  California  and  Europe,  and  has  now  regained  her  full  growth. 

A  boy,  now  fourteen,  had  pneumonia  at  the  age  of  four. 
Arrest  of  development  of  the  bones  of  the  face  is  very  marked ; 
he  has  stopped  growing  and  is  now  very  small  for  his  age. 

A  young  lady,  now  twenty-seven  years  of  age,  had  scarlet 
fever  at  the  age  of  four,  with  a  resultant  deaf-mutism.  The 
bones  of  the  face  and  jaws  are  undeveloped.  She  possesses  a 
marked  V-shaped  arch.  The  pits  and  grooves  upon  her  teeth 
denote  the  age  when  she  had  the  disease.  She  has  developed 
into  a  very  handsome,  full-grown  woman. 

A  lady,  now  forty-five  years  of  age,  had  scarlet  fever  at  three 
years.  Her  eyes  became  inflamed  and  she  lost  her  sight  for 
twenty-four  years,  when  they  gradually  grew  better.  The  bones 
of  the  face  were  arrested  in  development. 

Arrest  of  development  or  retardation  or  imperfection  may 
take  place  at  any  period  up  to  the  time  of  full  growth.  Arrest 
of  development  of  the  jaws,  however,  as  a  result  of  constitutional 
disease  must  occur  prior  to  the  sixth  year  to  produce  dental 


CONSTITUTIONAL    DISORDERS.  125 

deformities.  However,  this  is  somewhat  modified  by  the  influ- 
ence of  the  constitutional  disorders  on  the  hypophysis,  which 
may  lead  to  the  excessive  developments  of  bony  tissue  anywhere 
that  occur  especially  in  acromegaly,  giantism,  etc. 

Some  arrests  of  development  charged  to  direct  specificity  are 
in  reality  conditions  due  to  toxinic  or  nutritional  causes.  The 
"old  man"  appearance  of  congenital  syphilis  is  in  reality  an 
arrest  of  development  of  the  foetus  at  the  4.1-month  of  intra- 
uterine life ;  the  so-called  senile  period.  This  arrest  of  develop- 
ment is  produced  by  other  causes  than  syphilis,  whence  the  senile 
state  in  degenerates  described  by  Souques,  myself  and  others. 

One  expression  of  degeneracy  peculiarly  apt  to  occur  around 
the  periods  of  stress  is  the  condition  known  as  haemophilia,  which 
is  an  hereditary  constitutional  defect  evincing  itself  from  a  defi- 
cient coagulability  in  a  tendency  to  uncontrollable  bleeding, 
either  spontaneous  or  from  slight  wounds.  This  is  sometimes 
associated  with  sub-oxidization  conditions,  like  arthritis  and 
lipomatosis.  This  diathesis  has  long  been  known.  As  a  rule 
(to  which  exceptions  exist),  the  mother  of  the  haemophile, 
according  to  Nasse,  is  not  a  "bleeder"  herself,  but  is  the  daughter 
of  one.  The  daughters  of  a  hasmophile,  though  healthy,  transmit 
the  diathesis  to  the  male  offspring.  Haemophilia  generally 
appears  after  slight  injury  during  the  periods  of  the  first  denti- 
tion. 

The  Appleton  Swain  family,  of  Reading,  Mass.,  has  had 
"bleeders"  for  two  centuries.  Osier  has  reported  instances  in 
the  seventh  generation.  Kolster,  who  has  investigated  haem- 
ophilia in  women,  reports  a  case  in  the  daughter  of  a  female 
haemophiliac.  On  his  analysis  of  fifty  genealogic  trees  of  haem- 
ophiliac families,  it  is  evident  thatNasse's  law  of  transmission 
is  not  absolute.  In  fourteen  cases  the  transmission  was  direct 
from  father  to  child,  and  in  eleven  cases  it  was  direct  from  mother 
to  infant.  Haemorrhagic  symptoms  of  bleeders  are,  as  Gould 
points,  divisible  into  external  bleedings,  either  spontaneous  or 
traumatic  interstitial  bleedings,  petechias,  ecchymoses  and  joint 
affections.  External  bleedings  are  seldom  spontaneous,  but 
generally  follow  cuts,  bruises,  scratches.  A  minor  operation  on 
a  haemophile  may  prove  fatal.    So  slight  an  operation  as  draw- 


126  IRREGULARITIES    OF    THE    TEETH. 

ing  a  tooth  has  been  followed  by  the  most  disastrous  conse- 
quences. Gum  lancing-  is  equally  dangerous.  Healthy  blood 
placed  on  the  wound  has  often  so  coagulated  as  to  check  bleed- 
ing. This  produce  is  not  destitute  of  dangers  as  to  infection 
and  embolism.  Bleeder  families  are  often  multiparous,  healthy 
looking  and  have  fine,  soft  skins.  They  are,  hence,  not  often 
suspected  of  "bleeding"'  tendencies  by  the  practitioner  who  sees 
them  for  the  first  time. 


CHAPTER  XV. 


INTELLECTUAL  AND  MORAL  DEFECTS. 

There  is,  as  I  have  elsewhere  indicated/  a  complete  transi- 
tion from  the  durencephalic  (in  whom  the  chondrocranium  alone 
occurs)  monster  through  the  microcephalus,  the  idiot,  the  imbe- 
cile and  the  feeble-minded,  to  the  mentally  normal  person.  Be- 
tween the  feeble-minded  and  the  normal  individual  occurs  a 
group  whose  general  characteristics  are,  as  Alagnan  remarks, 
a  disharmony  and  lack  of  equilibrium  not  only  between  the  intel- 
lectual operation  properly  so-called  on  the  one  hand  and  the 
emotions  and  propensities  on  the  other,  but  even  between  the 
intellectual  faculties  themselves.  A  degenerate  may  be  a  scientist, 
an  able  lawyer,  a  great  artist,  a  poet,  a  mathematician,  a  poli- 
tician, a  skilled  administrator,  yet  present  from  a  moral  stand- 
point, profound  defects,  strange  peculiarities  and  surprising 
lapses  of  conduct.  As  the  ethic  element  (the  emotions  and 
propensities)  is  the  basis  of  determination,  it  follows  that  these 
brilliant  faculties  are  at  the  service  of  a  bad  cause,  of  the  instincts 
and  appetites  which,  thanks  to  will  defects,  lead  to  very  extrava- 
gant acts.  Sometimes  the  opposite  occurs.  Degenerates  of  irre- 
proachable character  may  show  defects  in  their  intellect,  may 
have  feeble  memory  in  certain  directions  or  may  be  unable  to 
understand  figures,  music  or  drawing.  In  a  word  an  otherwise 
normal  intelligence  is  lacking  as  regards  certain  faculties.  The 
centers  of  perception  are  unequally  impressionable;  are  unequally 
apt  to  gather  together  impressions  and  hence  register  some 
impressions  only  as  to  leave  durable  images.  Certain  relations, 
certain  associations  between  different  centers  are  perverted  or 
even  entirely  destroyed.  Nearly  normal  conditions  which  belong 
to  this  category  are  those  sentimentalists,  pessimists  and  neu- 
rotics. 

Great  as  is  the  apparent  gap  between  idiocy  and  one-sided 
genius,  on  the  one  hand,  and  between  idiocy  and  crime  on  the 

1  Degeneracy,  op.  Cit. 

127 


128  IRREGULARITIES    OF    THE    TEETH. 

other,  this  gap  is,  as  already  stated,  filled  by  numerous  closely 
interlinked  forms  dependent  on  the  proportionate  removal  of 
checks  (which  the  race  has  acquired  during  evolution)  on  the 
explosive  expressions  of  egotism.  The  removal  of  these  checks 
is  dependent  on  the  absence  or  weakening  of  brain  associating 
tracts.  The  idiot  capable  of  only  purely  vegetative  functions 
who  would  perish  were  food  not  placed  far  back  in  his  mouth, 
is  one  step  lower  than  the  normal  infant  who  is,  as  has  been 
remarked  by  Harriet  Alexander,"  an  egotistic  parasite.  On 
slightly  increased  development,  the  idiot  with  the  powers  of  a 
rather  low  animal,  gains  food  and  satisfies  its  instinct.  These 
instincts  at  this  stage  may  manifest  themselves  in  the  explosive 
manner  characteristic  of  the  undomesticated  and  non-social  ani- 
mals. With  these  instincts  may  appear  others  which  man  has 
long  lost.  Thus  an  idiot  girl  (who  was  delivered  of  an  infant 
when  alone)  gnawed  through  the  umbilical  cord  in  the  manner 
of  animals,  effecting  separation  and  preventing  hemorrhage.  At 
still  a  higher  stage  the  imbecile  may  manifest  destructive 
instincts,  may  steal  without  the  signs  of  remorse  exhibited  by  a 
housebred  dog  or  may  kill  without  recognizing  the  results  of 
killing.  The  intellect  may  be  comparatively  developed  in  certain 
imbeciles  in  comparison  with  the  ethical  defect.  For  lack  of 
proper  associating  fibers  the  imbecile  may  be  unable  to  acquire 
those  higher  associations  constituting  the  secondary  ego  in  the 
most  elevated  sense.  To  this  class  ultimately  belong  the 
instinctive  homicides,  torturers,  sexual  criminals  and  thieves  so 
frequently  found  among  the  juvenile  ofifspring  of  degenerate 
stock.  In  them  the  primary  ego  is  strong  and  the  restraints  of 
the  secondary  ego,  which  perceives  the  rights  of  others,  weak- 
'•ned  or  completely  absent.  This  class  forms  the  germ  of  the 
congenital  criminal,  whom  no  discipline  can  tame,  and  who  is 
therefore  incapable  of  being  taught  the  dangers  of  his  proced- 
ures under  the  law  of  the  land.  Between  this  class  and  the 
paranoiac  (or  "crank")  there  is  at  once  a  curious  likeness  and 
distinction.  The  lack  of  proper  associating  powers  prevents  the 
moral  imbecile  from  recognizing  any  rights  of  others.  The 
same  lack  in  the  paranoiac  prevents  him  from  recognizing  the 

-  Alienist  and  Neurologist,  1893-4. 


INTELLECTUAL    AND    MORAL    DEFECTS.  120 

force  and  rights  of  other  people  in  opinion.  The  moral  imbecile 
has  lost  the  greatest  acquirement  of  the  race  in  evolution,  that 
acquirement  which  fully  recognizes  the  secondary  ego  in  accord- 
ance with  the  sublime  precept :  "Do  unto  others  as  ye  would 
that  they  should  do  unto  you."  Closely  akin  to  that  instability 
of  inter-association  resulting  in  loss  of  proper  checks  on  explo- 
sive action  in  the  types  just  described  is  the  sentimentalism 
which  often  covers  real  hardness,  but  which  charms  and  allures 
the  mass.  This  has  essentially  the  psychologic  basis  of  the  sus- 
picional  tendencies  and  pessimism  with  which  it  is  so  often 
associated.  Suspicional  tendencies  arise  from  states  of  anxiety 
resultant  on  instability  of  association  dependent  on  lack  of  asso- 
ciating fibers.  Pessimism  (so  frequently  present  in  the  other- 
wise healthy  degenerates)  is,  as  Magalhaes  has  shown,  nervous 
instability  w'ith  alternations  of  irritability  and  prostration.  The 
subject  is  supersensitive,  impressions  call  forth  intense  and  pro- 
longed reaction  followed  by  exhaustion.  The  state  is  character- 
ized by  a  general  hypersesthesia,  which  naturally  results  in  an 
excess  of  suffering.  From  instability  and  hyperiesthesis  results 
discord  between  the  feelings  themselves,  between  the  feelings 
and  the  intelligence,  between  the  feelings,  the  ideas  and  the  will. 
Discord  between  the  feelings  shows  itself  in  a  great  variety  of 
paradoxes,  contradictions  and  inconsistencies.  To  the  pessimist 
possession  of  a  desired  object  does  not  atone  for  former  priva- 
tion. Pain  or  unsatisfied  desire  is  replaced  by  the  pain  of  ennui. 
With  inability  to  enjoy  what  he  has  are  coupled  extravagant 
expectations  regarding  that  which  he  does  not  have.  He  is 
extremely  susceptible  both  to  kindness  and  contempt.  He 
passes  suddenly  from  violent  irritability  to  languor,  from  self- 
confidence  and  vanity  to  extreme  self  abasement.  His  intense 
sensitiveness  results  in  the  intellectual  disorders  since  this 
involves  a  great  vivacity  of  the  intuitive  imagination  which  favors 
the  setting  up  of  extravagant  ideals  lacking  in  solid  representa- 
tive elements.  Hence  a  gap  opens  between  his  ideal  and  the 
actual.  He  can  never  realize  the  ideal  he  pursues  and  so  his 
feelings  are  of  a  somber  hue.  From  this  excessive  realism  results 
a  state  of  doubt,  a  certain  distrust  of  all  this  rational  objective 
knowledge.     It  assumes  another  form  in  extreme  subjectivism. 

10 


130  IRREGULARITIES    OF    THE    TEETH. 

The  pessimist  is  haunted  by  images  of  the  tiniest  rehgious  scru- 
ples, suspicions,  fears  and  anxieties  "resulting  in  alienation  from 
friends,  seclusions,  misanthropy.  The  pessimist  is  further  char- 
acterized by  an  incapacity  for  prolonged  attention  by  refractory 
attention  and  by  a  feeble  will.  These  result  in  inaction,  quietism, 
reverie,  self-abnegation,  abolition  of  the  personality  and  an 
annihilation  of  the  will  amounting  sometimes  to  poetic  or  relig- 
ious ecstasy.  Pessimism  is  frequently  associated  with  a  morbid 
fear  of  death. 

In  the  tramp,  to  the  restless  wandering  tendency  of  the  neu- 
rasthenic and  paranioac  are  added  the  parasitic  tendencies  of  the 
pauper  and  the  suspicional  egotism  of  the  less  intellectual  pessi- 
mist. 

The  one-sided  genius  is  a  link  between  the  neurotic  and  epi- 
leptic, the  paranoiac,  the  hysteric  and  the  imbecile.  Cases  crop 
up  in  which  all  these  elements  are  so  mingled  as  to  create  a 
puzzle  where  they  belong.  In  some  cases  in  accordance  with  the 
general  law  that  physiologic  atrophy  is  accompanied  by  hyper- 
trophy in  other  directions  the  intellectual  powers  other  than 
along  certain  lines  may  be  remarkably  deficient.  Moreover,  the 
intellectual  power  due  to  healthy  atavism  is  increased  seem- 
ingly by  the  degeneracy  in  certain  directions.  Without  going 
into  the-  question  raised  by  Lombroso'^  as  to  genius  being  an 
epileptoid  neurosis,  sufficient  evidence  exists  to  show  that  illy 
balanced  genius  often  co-exists  with  defects  in  a  large  number 
of  directions.  The  co-existence  of  genius  with  imbecility  and 
even  idiocy  has  been  well  illustrated  by  Langdon  Down,  who 
cites  numerous  instances  thereof.  Defect  in  genius  whether 
of  the  imbecile  stamp,  or  otherwise  accompanied  by  deficiency, 
is  not  expressed  in  the  genius,  but  in  its  deficient  accompani- 
ment. Even  the  mental  instability  of  the  highest  type  of  defective 
genius  is  close  kin  to  that  of  the  neurotic. 

Hysterics,  as  has  been  shown  by  Des  Champs,  are  neurotic 
women  in  whom  an  aggravated  sensibility  exists.  Neurotic 
women  are  divisible  into  three  categories,  according  to  the  pre- 
dominance of  one  of  the  three  centers ;  cerebral,  genital  and 
neuropathic.     These  types  occur  pure  or  intermixed.    The  gen- 

^  Man  of  Genius. 


INTKLI.KCTUAL     AND    MORAL    DKKKCTS.  181 

eral  characteristics  arc  want  of  equilibrium  in  sensiljility  and  will 
power.  Mobility  of  humor  occurs  in  direct  relation  with  facile 
impressionability  to  external  influences  or  to  internal  states. 
The  nerves  vibrate  to  mental  states  from  within  or  without 
and  all  are  registered  without  proper  relation.  One  fact  chased 
by  another  is  forgotten ;  still  another  fact  produces  a  momentary 
re-excitation  which  takes  place  of  truth  whence  falsehood 
becomes  instinctive,  but  the  patient  protests  her  good  faith  if 
accused  of  mendacity.  This  lack  of  equilibrium  leads  to  decided 
modification  of  the  mental  faculties.  Intellectual  activity  is 
over-excited,  but  in  diverse  degrees  and  variable  ways  accord- 
ing to  the  peculiar  tendencies  adopted.  Absorbed  by  a  pre- 
occupation or  controlled  by  an  idea  they  become  indifferent 
to  all  else.  The  ideas  are  abundant  and  the  idea  quickly  is  the 
act.  Their  vivid  imagination,  coupled  with  a  bright  intelligence, 
gives  them  a  seducing  aspect,  but  their  judgment  is  singularly 
limited,  attenuated,  and  therefore  false.  They  judge  from  a 
non-personal  standpoint  excellently.  They  are  quick  at  discover- 
ing faults  in  their  nearest  relatives,  but  faults  rightly  attributed 
to  themselves  are  repudiated.  Their  memory  is  capricious. 
They  forget  their  faults  and  their  acts  under  impulse  albeit  these 
may  be  consciously  'done.  The  cerebral  type,  led  by  the  intelli- 
gence, has  little  or  no  coquetry,  except  what  is  the  result  of 
mtention  and  temporary.  There  is  an  ethical  sense,  frankness 
and  nobility  in  her  ideas,  disinterestedness  and  tact  in  her  acts. 
She  is  capable  of  friendship.  Her  taste  carries  her  to  male  pur- 
suits in  which  she  succeeds.  She  becomes  often  what  is  called 
a  "superior  woman,"  and  too  often,  what  is  called  an  "incom- 
prehensible woman."  She  has  little  guile.  To  the  sensual  type, 
voluptuousness  is  the  aim  of  life  and  the  center  of  her  acts  and 
thoughts.  She  is  well  endowed  VN^ith  guile  and  extremely  diplo- 
matic, full  of  finesse,  but  not  very  delicate.  Her  lack  of  scruple 
often  spoils  her  tact.  She  is  ruseful,  dissimulating  and  uncon- 
sciously mendacious.  She  despises  friendship  and  needs  watch- 
ing. If  circumstances  permit  she  loses  her  delicacy,  reserve 
and  modesty.  She  is  destitute  of  scruples  and  her  crimes  are 
coolly  remorseless.     The  neuropathic  type  is  one  to  which  the 


132  IRREGULARITIES    OF    THE    TEETH, 

grasshopper  is  a  burden.  Her  nerves  are  always  on  edge  and 
she  is  a  "heroic"  invalid  whom  trivialities  martyrize. 

The  character  of  the  neurotic,  as  Kiernan  remarks,  recalls 
the  observation  of  Milne-Edwards  concerning  the  monkey 
character.  Levity  is  one  of  its  salient  features  and  its  mobility 
is  extreme.  One  can  get  it  to  shift  in  an  instance  from  one  mood 
or  train  of  ideas  to  another.  It  is  now  plunged  into  black 
melancholia  and  in  a  moment  may  be  vastly  amused  at  some 
object  presented  to  its  attention.* 

Neuroticism  in  man  dififers  from  that  in  woman  only  in  the 
fact  that  anaesthesia,  paralysis  of  emotional  origin  and  conscious 
convulsions  are  less  common.  The  male  neurotics  are  sub- 
divisible precisely  as  the  female.  Neurotics  are  often  long 
lived,  peculiarly  resistant  to  certain  acute  and  fatal  diseases,  and 
frequently  retentive  of  their  youthful  appearance.  This  last 
is  to  a  certain  extent  evidence  of  their  resistance  to  the  wear 
and  tear  of  life  and  advancing  old  age,  and  is  due  to  emotional 
anaesthesia.  Recognition  of  the  neurotic  tendency  often  induces 
the  individual  to  take  better  care  of  himself.  The  youthful 
appearance  is  often  also  largely  the  result  of  arrest  of  facial 
development  at  an  early  age.  The  face  therefore  retains  the 
child  character  throughout  life.  This  class  of  neurotics 
(which  does  not  include  those  afflicted  with  the  more  serious 
nervous  disorders,  such  as  epilepsy),  may  be  looked  upon  as 
the  victims  of  evolutionary  processes,  constantly  going  on  in 
the  race  and  especially  under  civilized  conditions.  Neurotics 
are  not  met  with  to  any  extent  among  barbarous  races,  but 
are  numerous  in  civilized  communities  where  the  weak  are 
preserved  from  early  death  and  then  subjected  to  the  struggle 
for  existence.  Neurotics  are  individuals  naturally  imperfect 
in  some  directions,  but  by  the  law  of  economy  of  growth  often 
superior  in  others.  Their  disordered  nervous  functions  and 
hypersesthesias  are  not  necessarily  indicative  of  inferiority  of 
general  organization  compared  to  their  ancestry.  They  may 
simply  imply  a  more  rapid  advance  in  some  one  direction  in 
the   development  of  the  nervous  system  than  has  been  kept 

*  Review  of  Nervous  and  Mental  Disease,  1891. 


INTELLECTUAL    AND    MORAL    DEFECTS.  133 

up  with  by  the  remainder.  These  defects  may  sometimes  be 
advance  g-uards  in  the  progress  of  the  development  of  the  race.^ 

Epilepsy,  which  is  chiefly  viewed  from  the  standpoint  of  its 
"fit,"  has  far  more  extended  mental,  moral  and  other  nervous 
relationship.  It  is,  as  Spitzka  shows,  a  morbid  state  of  the 
brain  without  a  palpable  lesion,  manifesting  itself  in  explosive 
activity  of  an  unduly  irritable  vaso-motor  center,  leading  to 
complete  or  partial  loss  of  consciousness  which  may  be  pre- 
ceded or  followed  by  various  phenomena  expressing  the  undue 
preponderance  of  some  and  the  suspended  inhibitory  influence 
of  other  cerebral  districts. 

True  epilepsy  presents  an  enormous  number  of  sub-groups, 
exhibiting  every  variety  of  deviation  from  the  ideal  convulsive 
form,  and  the  existence  of  these  forms  tends  to  demonstrate 
the  views  just  expressed.  In  ordinary  petit  mal  the  initial 
arterial  spasm  has  but  to  be  confined  to  the  surface  of  the  hem- 
ispheres leaving  the  thalamus  ganglia  undisturbed,  and  it  can 
readily  be  understood  how  the  momentary  unconsciousness 
or  abolition  of  cortical  function  can  occur  without  the  patient 
falling,  his  automatic  ganglia  still  carrying  on  their  functions. 
At  the  same  time  with  the  lesser  spasm  there  would  be  a  less 
extensive  sinking  of  intracranial  pressure  and  less  consecutive 
collateral  hyperaemia  of  the  lower  centers  and  therefore  no 
convulsion.^ 

In  certain  cases,  as  Meynert  has  suggested,  arterial  spasm 
may  fail  to  affect  the  entire  cortical  surface  simultaneously,  some 
one  trunk  may  be  more  previous  and  as  afflux  of  blood  may 
occur  in  its  special  field  where  certain  impressions  and  motor 
innervations  are  stored ;  the  result  will  then  be  that  the  func- 
tion of  the  relatively  well  nourished  territory  will  be  exalted. 
If  it  be  a  visual  perception  territory,  sights,  colors  or  luminous 
spectra  will  be  seen,  if  it  be  an  olfactory  territory,  odors  will  be 
smelt,  if  a  tactile  center,  crawling,  tingling  and  cold  sensation, 
if  a  speech  center,  cries,  phrases  and  songs  may  be  observed. 
Thus  occur  the  manifold  epileptic  aura  which  is  simply  an  iso- 
lated   exaggerated    limited    cortical   function.      The    recurrence 

^  Evolution  by  Atrophy^  DeMoor. 

6  New  England  Medical  Monthly,  1881. 


134  IRREGULARITIES    OF    THE    TEETH. 

of  the  aura  is  readily  explicable  on  the  ground  of  the  well- 
known  physiologic  law  that  any  nervous  process,  morbid 
or  normal,  having  run  through  certain  paths,  those  paths  will  be 
the  paths  of  least  resistance  for  that  process  to  follow  in  the 
future.  To  an  extension  of  the  same  conditions  are  due  the 
peculiar  convulsive  equivalent  and  post-epileptic  mental  states. 

Behind  the  moral  disorders  of  idiots,  imbeciles,  some  crim- 
inals, some  paupers  and  some  prostitutes  is  the  epileptic  state. 
There  is  no  mental  or  moral  disorder  which  may  not  occur  as 
a  substitute  for  the  "fit." 

The  moral  defects  of  epilepsy  have  not  unnaturally  led  to  the 
opinion  that  crime  was  an  expression  of  disease  or  mal-devel- 
opment.  Crime  being,  however,  a  matter  of  law  rather  than 
ethics,  must  be  dealt  with  from  the  standpoint  of  individual 
criminals.  Tyndall'  was  convinced  that  the  classification  given 
him  by  a  governor  of  a  great  British  prison,  was  of  truly  prac- 
tical value.  Criminals  according  to  this  classification  were 
divisible  into  three  types :  First,  those  whom  external  accident 
and  internal  taint  had  brought  within  the  grasp  by  the  law. 
They  were  essentially  of  sound  moral  stamina,  though  wearing 
the  prison  garb.  Then  came  those  with  no  strong  bias,  moral 
or  immoral,  plastic  to  the  touch  of  circumstances  which  would 
mold  them  into  either  good  or  evil  members  of  society.  Thirdly, 
came  a  class,  happily  not  a  large  one,  whom  no  kindness  could 
conciliate  and  no  discipline  tame.  They  were  sent  into  the 
world  labeled  incorrigible.  Havelock  Ellis,'^  following  a  similar 
principle,  divides  criminals  into  political  criminals  who  are  not 
necessarily  guilty  of  any  anti-social  ofifence.  From  the  Eight- 
eenth Century  British  statutory  standpoint,  Washington, 
Jefferson,  Franklin  and  the  Signers  of  the  Declaration  of  Inde- 
pendence were  all  criminals  of  this  type.  The  political  criminal 
of  one  age  or  land  may  therefore  be  the  martyr,  saint,  or  hero, 
of  another.  The  criminal  from  passion  like  the  man  who  resents 
the  dishonor  of  his  daughter,  sister  or  wife,  is  a  modification 
of  the  first  type  described  by  Tyndall.  The  instinctive  crim- 
inal, otherwise  the  moral  imbecile,  is  the  third  type  of  Tyndall. 

'  Lectures  cited  by  C.  K.  Mills,  Pa.  Med.  Society  Trans.,  1882. 
®  The  Criminal. 


INTELI.ECTUAT,    AND    MORAL    DEFECTS.  '135 

The  periodic  criminal  who  suddenly  breaks  out  into  anti-social 
acts  at  more  or  less  regular  intervals  is  closely  allied  to  the  epi- 
leptic and  the  periodic  lunatic  whether  cyclothymiac  (circular  in- 
sanity), maniac,  melancholiac,  dipsomaniac,  nymphomaniac,  or 
other  types.  Then  there  is  a  large  class  of  law  made  or  society 
made  criminals,  whose  crimes  are  violations  of  law,  but  the 
reverse  of  anti-social  in  nature.  Thus  during  the  reign  of  the 
normally  imbecile  paranoiac  George  III.  of  England,  the  hus- 
band of  a  hard-working,  honest  woman  was  seized  by  a  press 
gang  and  forced  to  serve  in  a  fleet  which  sailed  with  troops  for 
America.  He  left  her  destitute  with  six  children,  one  just  born. 
To  avoid  starvation  for  them  she  stole  a  bolt  of  cloth,  but 
troubled  by  conscience  she  returned  it,  was  caught,  tried  and 
hanged  for  example.  The  babe  was  nursing  at  her  breast  just 
ere   the  black  cap  was  put  on. 

Criminals  on  occasion  like  this  one  may  be  made  into  habitual 
criminals  by  despair  and  from  the  evil  associations  into  which 
the  law  flings  them.  The  criminals  of  the  political  and  occa- 
sional type  are  often  further  removed  from  degeneracy  than  the 
criminal  within  the  law  type  :  the  dominant  type  of  the  century 
just  closed. 

From  this  fact  comes  the  negative  results  of  so  many 
researches  in  prisons.  These  negative  results  also  are  due  to 
the  observation  being  made  by  tyros  in  medico-anthropometric 
examination  and  classification. 

Nine  decades  ago,  Grohman,^  who  made  positive  observa- 
tions of  this  kind  and  was  "impressed  in  criminals,  especially 
in  those  of  defective  development  by  the  prominent  ears,  the 
shape  of  the  cranium,  the  projecting  cheek  bones,  the  large, 
lower  jaws,  the  deeply  placed  eyes,  the  shifty  animal-like  gaze." 
Despine's  researches  revealed  the  absence  of  human  checks  on 
the  instinctive  tendencies  in  criminals.  These  started  from  the 
doctrine  of  moral  imbecility  as  elaborated  by  Rush,  Prichard, 
Brigham,  Ray,  Gait,  C.  H.  Hughes,  and  others.  Bruce  Thom- 
son, testing  Despine's  results  by  primitive  races  and  Scotch 
criminals,  found  that  defective  abnormal  and  anomalous  states 
of  the    instinctive    faculties    exist    in    entire    races    and    in    the 

9  Havelock  Ellis,  Op.  Cit. 


136  IRREGULARITIES    OF    THE    TEETH. 

"moral  idiots"  that  occur  in  the  best  races.  Criminals  are  a 
variety  of  the  human  family  quite  distinct  from  the  law  abiding 
men.  A  low  type  of  physique  indicating  a  deteriorated  char- 
acter gives  a  family  likeness,  due  to  the  fact  that  they  form  a 
community  which  retrogrades  from  generation  to  generation. 
The  low  physical  condition  of  juvenile  criminals  in  reforma- 
tories, etc.,  becomes  at  once  obvious  if  they  be  compared  with 
healthy,  active  school  children.  They  are  puny,  sickly,  scrofu- 
lous, often  deformed  with  peculiar  unnaturally  developed  heads, 
sluggish,  stupid,  liable  to  fits,  mean  in  figure  and  defective  in 
vital  energy,  while  at  the  same  time  they  are  irritable,  violent 
and  too  often  quite  incorrigible.  The  adults  usually  have  a 
singularly  stupid  and  insensate  look.  The  complexion  is  bad. 
The  outlines  of  the  head  are  harsh  and  angular.  The  boys  are 
ugly  in  feature  and  have  as  a  rule  repulsive  appearances.  These 
diseases  of  criminals  are  a  proof  of  their  low  type  and  deterio- 
rated conditions.  Their  deaths  are  mainly  due  to  tubercular 
disease  and  affections  of  the  nervous  system.  In  the  greater 
number  crime  is  hereditary  which  is,  in  most  cases,  associated 
with  bodily  defect  such  as  spinal  deformities,  stammering  or 
other  imperfect  speech,  club-foot,  cleft  palate,  hare-lip,  deformed 
jaws  and  teeth,  deaf-mutism,  congenital  blindness,  paralysis, 
epilepsy  and  scrofula. 

Elisha  Harris,  of  New  York,  among  233  convicts  found  54 
to  belong  to  families  in  which  insanity,  epilepsy  and  other 
neurosis  existed.  Eighty-three  per  cent  belong  to  a  criminal 
pauper  or  inebriate  stock  and  were  therefore  hereditarily  or 
congenitally  afifected.  Nearly  76  per  cent  of  their  number  hence 
proved  habitual  criminals.  According  to  Harris  pauperism  and 
insanity  so  revert  into  each  other  that  insanity  in  the  parent 
produces  crime  or  pauperism  in  the  offspring  or  vice  versa ; 
crime  or  pauperism  in  the  parent  produces  disease  or  insanity  in 
the  offspring.  Campagne,  Broca,  G.  Wilson  and  others  about 
the  same  time  made  similar  researches. 

The  American  sociologist  Samuel  Royce,  after  a  careful 
study  of  American  and  European  defective  classes  found  that 
observation  of  the  hereditary  nature  of  pauperism  which  con- 
genitally reverts  into  insanity,  disease  or  crime,  leaves  no  doubt 


INTELLECTUAL    AND    MORAL    DEFECTS,  137 

but  that  pauperism  is  one  of  the  worst  forms  of  race  deterio- 
ration and  that  the  paralysis  of  the  human  will  and  its  energies 
is  but  the  result  of  a  fearful  dissolution  in  progress. 

The  pauper,  inebriate,  opium  user,  and  cocaine  habitue  may 
be  all  divided  as  the  criminals  have  already  been.  In  the  occa- 
sional type  whatever  defects  may  be  produced  on  the  offspring 
as  regards  degeneracy,  the  stigmata  need  not  necessarily  be 
expected  in  the  irxlividual  victim  of  circumstances.  In  the 
periodic  and  instinctive  types  such  as  stigmata  will  occur  with 
as  great  frequency  as  in  other  cases  of  these  types.  The  fact 
is  often  forgotten  that  the  criminal  manifestation  of  the  periodic 
type  as  well  as  the  pauper  manifestation  may  be  a  mere  tinge 
of  the  underlying  degeneracy  which  would  be  present  and 
evince  itself  in  some  other  morbid  way  did  not  the  pauper,  .crim- 
inal or  other  tinge  make  its  appearance.  There  is,  however, 
a  pseudo-periodicity  produced  by  pauperism,  crime,  alcohol  and 
other  conditions  w^iich  turns  on  the  nerve  law  of  periodicity 
already  referred  to.  In  the  pseudo-periodic  type  degenerative 
conditions  while  occurring  far  more  frecjuently  than  in  the  occa- 
sional types  are  much  less  frequent  than  in  the  true  innate 
periodic  types.  The  pauper  type  contains  more  of  the  occa- 
sional type  than  the  criminal  or  prostitute,  but  less  than  the 
inebriate. 

The  tramp  contains,  however,  like  the  prostitute,  more  of 
the  degenerative  types.  In  him  are  found  the  restless  wander- 
ing tendencies  of  the  neurasthenic  and  paranoiac  added  to  the 
parasitic  tendencies  of  the  pauper  and  the  suspicional  egotism 
of  the  "reasoning  maniac."  In  a  general  way  it  may  be  said  that 
degenerative  conditions  of  skull,  jaws  and  teeth  of  all  the  cases  of 
intellectual  and  moral  defect  are  excellently  illustrated  by  those 
found  in  the  prostitute.  This  will  be  obvious  on  comparison  of 
those  hereinafter  given  of  the  prostitutes  with  the  tables  regard- 
ing other  classes  to  be  found  in  the  appendix. 

As  has  been  remarked  by  Airs.  Ballington  Booth,  of  the 
Salvation  Army,  a  by  no  means  small  proportion  of  the  prosti- 
tute class  are  illustrations  of  the  Bibhcal  axiom  that  "the 
fathers  have  eaten  sour  grapes  and  the  children's  teeth  are  set 
on  edge."    Her  conclusions  are  borne  out  by  the  results  of  the 


138  IRREGULARITIES    OF    THE    TEETH. 

studies  of  Chaplain  Merrick,  of  the  Milbank  prison,  and  by 
those  of  PauHne  Tarnowsky,  Lombroso,  Grimaldi,  Andronico 
and  myself.  Tarnowsky^*^  finds  that  prostitution  is  crime  in 
women  taking  the  line  of  least  resistance.  Prostitutes,  like  other 
criminals,  are  divisible  into  criminals  on  occasion  (vice,  mone- 
tary reasons,  etc.),  accidental  criminals,  law-made  criminals,  weak- 
willed  criminals,  periodic  criminals,  born  criminals  and  insane 
criminals.  The  proportion  of  law-made  and  accidental  crim- 
inals in  the  prostitute  class  is  much  less  than  among  other 
criminals.  Seduction  stands  very  low  in  the  list  of  causes.  The 
proportion  of  the  weak  willed  criminal  type  is  very  large.  In 
addition  to  arriving  at  similar  general  conclusions  to  those  of 
Chaplain  Merrick  and  Mrs.  Booth,  Tarnowsky^i  points  out  that 
the  professional  prostitute  is  usually  a  degenerate  being,  the 
subject  of  an  arrest  of  development,  tainted  with  a  morbid  hered- 
ity and  presenting  physical  and  mental  stigmata  fully  in  con- 
sonance with  her  imperfect  evolution.  The  physical  stigmata 
due  to  an  imperfect  organization  are  manifested  in  prostitutes 
princi])ally  by  the  frequency  of  skull  deformities  (44%  per  cent), 
face  deformities  (42%  per  cent),  ear  anomalies  (42  per  cent), 
and  teeth  anomalies  (54  per  cent).  The  mental  stigmata  are 
more  or  less  marked  intellectual  feebleness  with  a  notable 
deficiency  of  moral  sense. 

Of  150  prostitutes  taken  at  random  from  those  meeting  the 
necessary  requirements  (uniformity  of  race,  ability  to  give  their 
family  history,  and  for  years  resident  of  houses  of  prostitution), 
Dr.  Tarnowsky  found  signs  of  physical  degeneracy  in  eighty- 
seven  per  cent.  The  following  abnormalities  were  noted. 
Deformities  of  the  bony  cranium,  sugar-loaf  heads  (oxycephaly), 
heads  flattened  at  the  vertex  (platycephaly),  narrow  heads,  com- 
pressed at  the  temples  (stenocephaly),  oblique  crania  (plagio- 
cephaly),  heads  with  marked  depressions  or  cavities  whether  in 
the  region  of  the  bregma  or  that  of  the  lambda.  All  these 
cranial  malformations  may  depend  upon  different  causes.  Arrest 
of  development  of  the  bones ;  premature  synostosis  of  the 
sutures ;  pathologic  processes  during  intrauterine  life  or  early 

^''  Lcs  Voleu.scs  et  Prostituees. 
11  Degeneracy,   Op.   Cit. 


INTELLECTUAL    AND    MORAL    DEFECTS. 


139 


infancy  (syphilis,  rickets,  scrofulous  affections,  hydrocephalus) 
meningitis,   etc. 

Recklinghausen,  of  .Strassburg,  claims  that  in  infant  crania, 
premature  synostosis  of  the  sutures  may  produce  (according  as 
one  or  all  of  the  sutures  are  involved)  either  dolichocephaly 
(sagittal  suture),  trocho-  and  oxycephaly  (generalized  synostosis) 
or  plagiocephaly  (coronary  suture  of  one  side).  The  girth  of  the 
brain,  and  skull,  he  states,  influence  each  other  reciprocally  and 
form  of  the  cranium,  especially  the  pathologic  forms,  is  ordinar- 
ily the  result  of  any  concurrent  conditions.  It  mav  depend  as 
much  upon  disturbances  of  the  development  of  the  sutural  syn- 


Fig.  A. 


Fig.  B. 


Fig.  C. 


ostosis  or  of  the  bone  as  upon  primordial  anomalies  in  brain 
development. 

Deformed  heads  in  prostitutes  present  marked  development 
of  the  external  occipital  protuberance  in  one-third  of  the  cases. 
In  an  equal  numxber  of  virtuous  women  it  was  found  but  five 
times.  Among  the  abnormal  skull  types  presented  were  three 
herewith  illustrated.  In  the  first  the  head  was  flattened  at  the 
vertex,  the  forehead  was  hydrocephalic,  the  nose  flat  and  the 
lobe  of  the  ear  as  much  developed,  (Fig.  A).  In  the  second, 
the  head  was  elevated  at  the  vertex  and  the  nose  flat,  (Fig.  B). 
In  the  third  type  the  parietal  region  was  asymmetrical,  (Fig. 
C).  The  anomalies  of  the  face  were  marked  asymmetry,  sub- 
nasal  prognathism  and  disproportion  of  different  parts.     There 


140  IRREGULARITIES    OF    THE    TEETH. 

was  deviation  of  the  nose  and  deep  excavation  of  its  root. 
The  nose,  being  often  strongly  flattened,  the  Gothic  palatine 
vault  occurred  very  frequently.  There  was  frequently  com- 
plete division  of  the  palate.  There  were  teeth  defective,  irregu- 
lar in  growth,  riding  over  each  other  or  widely  separated.  The 
teeth  were  often  notched  and  grooved  (Hutchinson's  and  Par- 
rot's teeth).  The  teeth  often  encroached  outside  of  the  dental 
arch,  the  parabola  of  which  was  thus  rendered  irregular.  There 
was  atrophy  or  complete  absence  of  the  superior  lateral  incisor. 
The  anomalies  were  thus  distributed  among  the  150  examined. 
Malformation  of  the  head  (oxycephaly,  plagiocephaly,  etc.) 
noted  in  sixty-two  women. 

Development   of  the   occipital   protuberance 62  Women 

Very  receding  foreheads 18  " 

Hydrocephaly    15  " 

Face  anomalies  (sub-nasal  prognathism,  asymmetry, 

etc. )    64  " 

Gothic  palatine  vault   38  " 

Cleft  palate  14  " 

Vicious   implantation    of  teeth 62  " 

Hutchinson's  and   Parrot's  teeth 19  " 

Absence  of  lateral   incisors    10  " 

Badly  margined  ears  (Morel) 16  " 

Defective  ears  (detached     from     head,     deformed, 

etc.)    47 

Anomalies  of  the  extremities 8  " 

These  anomalies  were  found  in  the  following  numbers  in 
the   same   individual. 

In  15  prostitutes,  a  single  anomaly,  or  one  in  10   per   cent. 
In  34  prostitutes,  2  anomalies  at  once,  or  22.66  per  cent. 
In  35  prostitutes,  3  anomalies  at  once,  or  23.33  per  cent. 
In  thirty  prostitutes,  4  anomalies  at  once,  or  20  per  cent. 
In  14  prostitutes  5  anomalies  at  once,  or  9.33  per  cent. 
In  66  prostitutes,  6  anomalies  at  once,  or  6  per  cent. 
In  4  prostitutes,  7  anomalies  at  once,  or  2.66  per  cent. 
In  I  prostitute,  8  anomalies  at  once,  or  0.66  per  cent. 

Eliminating  the  first  fifteen  women  presenting  only  one 
anomaly  (who  must  not  therefore  be  classed  as  badly  organ- 
ized) and  with  them  one  prostitute  who  showed  no  physical 
deviation,  the  other  134  prostitutes  show  (82.6  per  cent  of  the 


INTELLECTUAL    ANT)    MORAL    DEFECTS.  141 

whole)  more  than  one  anomaly  at  the  same  time.  Respectable 
women  (both  illiterate  and  cultured)  show  an  enormous  differ- 
ence. Amongst  educated  women  were  found  but  two  per  cent 
of  anomalies  and  among  illiterates  14  per  cent. 

Lombroso,  in  an  examination  of  50  prostitutes,  found 
exaggerated  lower  jaw  twenty-six  times ;  plagiocephaly,  twenty- 
three  times ;  asymmetrical  noses,  eight  times ;  prominent  zygo- 
ma, forty  times.  Grimaldi  had  from  the  study  of  twenty-six 
prostitutes  similar  results  to  those  of  Tarnowsky. 

C.  Andronico  (vv^ho  was  among  the  first  to  describe  stigmata 
of  degeneracy  in  prostitutes)  found  among  230  the  following 
anomalies.  Flat  nose,  twenty  times;  handle-shaped  ears, 
thirty-five  times ;  vicious  implantation  of  teeth,  ten  times ;  con- 
vergent strabismus,  two  times;  facial  asymmetry,  four  times; 
prognathism,  seven  times ;  receding  foreheads,  thirty-five  times. 
Some  eight' years  ago  I  made,  in  company  with  Harriet  C. 
B.  Alexander  and  J.  G.  Kiernan,  researches  in  the  Chicago 
"bridewell."  The  prostitutes  here  confined  are  the  least  intelli- 
gent of  the  class.  The  researches  are  necessarily  far  from  com- 
plete, owing  to  the  difficulties  under  which  such  researches  must 
be  made  in  case  of  persons  with  short-term  sentences.  They 
were,  however,  habitual  offenders,  some  being  in  the  institution 
from  time  to  time  for  twenty  years. 

The  number  examined  was  thirty,  with  the  following  results : 
Race. 

Celtic-Irish    I3  American 2 

Irish-American    5  English-American    i 

Scandinavian    3  Latin-Swiss   i 

German  i  Negro    •■•     2 

German-American     I 

These  results  tell  relatively  little  since  the  system  of  "fining" 
in  Heu  of  imprisonment,  of  Chicago  places  only  the  "obtuse" 
class  under  imprisonment.  One  was  seventeen  years  old,  two 
eighteen  years,  one  nineteen  years,  five  between  twenty  and 
twenty-five  years,  three  between  twenty-five  and  thirty,  six 
between  thirty  and  thirty-five,  five  between  thirty-five  and  forty- 
five,  one  was  forty-six  years  old,  two  were  fifty-five,  three  sixty, 
and  one  sixty-five.  Neither  race  nor  age  data  are  of  special 
value.     There  were  eighteen  blondes,  ten  brunettes  and  two 


142 


IRREGULARITIES    OF    THE    TEETH. 


negroes.  Four  were  demonstrably  insane,  and  one  was  an  epi- 
leptic. 

In  sixteen  cases  the  zygomatic  process  were  unequal  and 
very  prominent.  There  were  fourteen  other  asymmetries  of 
the  face.  Three  heads  were  Mongoloid ;  one  Irish-Celt,  one 
Swiss  and  one  Scandinavian.  There  were  Mongoloid  race  types 
in  the  regions  where  the  first  two  come.  Sixteen  were  epignathic 
and  eleven  sub-nasally  prognathic.  In  one  there  was  arrest  of 
development  of  the  lower  jaw  and  in  four  arrest  development 
of  the  bones  of  the  face.     The  nose  was  abnormal  in  six. 

There  were  seventeen  brachycephalic  and  thirteen  mesat- 
icephalic  skulls.     There  were  no  dolichocephalic  skulls.     There 


Fig.  A. 


Fig.  B. 


Fig.  c. 


were  three  oxycephalic  skulls  of  v.-hom  one  was  a  Celt,  one  a 
German  and  one  a  Scandinavian.  There  were  eighteen  dome- 
type  skulls  of  whom  seven  w^ere  Irish-Celts,  five  Celtic-Amer- 
icans, one  English  Anglo-Saxon,  one  American  Anglo-Saxon, 
and  one  German-American.  There  were  four  tectocephalic 
skulls  of  whom  one  was  an  Irish-Celt,  one  an  Anglo-Saxon 
American  and  one  a  Scandinavian.  There  were  three  platy- 
cephalic skulls  of  whom  two  were  Celts  and  one  a  Scandinavian. 
There  was  one  plagiocephalic  German  and  a  stenocephalic  Celt. 
One  skull  had  a  protuberance  at  the  bregma.  Twelve  occiputs 
were  flattened  in  four  of  which  there  was  no  tubercle ;  eighteen 
had  an  enormously  developed  occipital  protuberance. 

Twenty-nine  had  defective   ears ;   eleven  were  of  the  type 
shown  in  Fig.  A;  nine  of  the  type  shown  in  Fig.  B.,  and  nine 


INTEI.I.KCTUAL    AND    MORAI.    DKKRCTS.  143 

of  the  type  C.  Normal  cars  were  present  in  a  member  of  a 
family  which  had  furnished  one  mother  and  two  sisters  to  the 
institution.  Five  Celtic-Irish  had  type  A,  and  three  Celtic- 
Americans,  seven  Celtic-Irish  and  one  Celtic-American  had 
type  B.  One  Irish-Celt  and  one  American-Celt  had  type  C. 
One  Celt  had  type  A.  One  German  and  one  German-Amer- 
ican had  type  C.  The  negroes  had  type  C.  One  Anglo-Saxon 
American  had  type  C,  and  one  English  Anglo-Saxon  had 
type  A.  The  Scandinavians  (all  more  or  less  mentally  defective) 
presented  all  three  types.  Frigerio  (corroborating  a  fact  long 
ago  pointed  out  by  Morel)  has  said  that  the  ear  should  be 
placed  in  the  first  rank  among  the  organs  affected  by  degen- 
eracy. 

The  table  XI  in  the  appendix  shows  the  measurements  and 
percentage  of  jaw  deformity. 

An  allied  class  belonging  to  a  still  blacker  phase  of  biology 
are  the  sexual  perverts.^-  The  congenital  form  which  is  asso- 
ciated with  the  stigmata  of  degeneracy  is  an  expression  of  the 
defective  line  whence  the  victim  is  sprung.  Like  the  prostitute, 
the  sexual  pervert  may  be  divided  into  precisely  the  same  crim- 
inals as  other  criminals. 

Between  the  criminal  and  the  insane  is  a  debatable  line 
occupied  by  moral  imbeciles,  reasoning  maniacs,  etc.  In  many 
insane  the  most  demonstrable  deviation  from  the  normal  con- 
sists in  disorder  of  the  moral  faculties.  This  is  the  striking 
factor  of  the  case  since  superficially  the  mind  otherwise  appears 
clear  and  rational  by  contrast.  In  these  cases,  as  Krafft-Ebing 
has  shown  the  most  striking  features  are  moral  insensibility, 
lack  of  moral  judgment  and  ethical  ideas.  The  place  of  these 
is  usurped  by  a  narrow  sense  of  loss  or  profit  logically  appre- 
hended only.  Such  persons  may  mechanically  know  the  law 
of  morality.  If  such  law^s  enter  their  consciousness  they  do  not, 
however,  experience  real  appreciation,  still  less  regard  for  them. 
The  laws  to  them  are  cold  lifeless  statements.  The  morally 
defective  know  not  how  to  draw  from  them  motive  for  omission 
or  commission.  To  this  "moral  color-bHndness"  the  whole 
moral  and  governmental  order  appears  as  a  mere  hindrance 
1-  Kiernan,  Detroit  Lancet,  1884. 


144  IRREGULARITIES    OF    THE    TEETH. 

to  egotistic  ambition  and  feeling  which  necessarily  leads  to 
negation  of  the  rights  of  others  and  to  violation  of  the  same. 

These  defective  individuals  are  without  interest  for  aught 
good  or  beautiful,  albeit  capable  of  a  sentimentality  which  is 
shallow  cant.  Such  persons  are  repellent  by  their  lack  of  love  for 
children  or  relatives  and  of  all  social  inclinations  and  by  cold- 
hearted  indifference  to  the  weal  or  woe  of  those  nearest  to 
them.  They  are  without  other  than  egotistic  care  for  ques- 
tions of  social  life,  sensibility  to  either  the  respect  or  the  scorn 
of  others,  without  control  of  conscience  and  without  sense  of 
or  remorse  for  evil.  Morality  they  do  not  understand.  Law 
is  nothing  more  than  police  regulation.  The  greatest  crimes 
are  regarded  as  mere  transgressions  of  some  arbitrary  order. 
If  such  persons  come  to  conflict  with  individuals,  ^then  hatred, 
envy  and  revenge  take  the  place  of  coldness  and  negation  and 
their  brutality  and  indifference  to  others  know  no  bounds. 

These  ethically  defective  persons  (where  incapable  of  hold- 
ing a  place  in  society)  are  often  converted  into  candidates  for 
the  workhouse,  jail,  or  the  insane  hospital.  One  or  the  other 
of  these  places  they  reach  after  they  have  been,  as  children, 
the  terror  of  parents  and  teachers  through  their  untruthful- 
ness, laziness  and  general  meanness  and  in  youth  the  shame 
of  the  family  and  the  torment  of  the  community  and  the  ofificers 
of  the  law,  by  thefts,  vagabondage,  profligacy  and  excesses. 
Finally  they  are  the  despair  of  the  insane  hospital,  the  "incor- 
rigibles  of  the  prisons,"  the  veritable  burdens  of  the  poor- 
house.  If  intellectual  insanity  or  crime  do  not  claim  them, 
pauperism  or  criminality  is  likely  to  be  their  destiny.  The 
moral  imbecile  may,  however,  keep  within  the  law  and  achieve 
business  success.  His  descendants  often  evince  degeneracy 
in  an  aggravated  form.  ]\Iany  of  the  "reformers"  of  various 
alleged  social  evils  are  often  of  this  class.  Their  morbid 
egotism  takes  the  direction  of  cant  and  sentimentality  so  com- 
mon at  certain  states  of  evolution  as  points  of  least  resistance. 
Like  Guiteau,  the  assassin  of  President  Garfield,  they  aim  at 
doing  a  "big  thing  for  humanity  and  myself,"  the  humanity  being 
concentrated   in  "my"   ideas. 

The  moral  lunatic  needs  but  a  slight  twist  intellectually  to 


INTELLECTUAL    ANU    MORAL    DEIKCTS.  145 

become  the  paranoiac  to  whom  there  is,  as  Spitzka'^  has  pointed 
out,  a  permanent  undercurrent  of  perverted  mental  action, 
pecuHar  to  the  individual  running  Hke  an  unljroken  thread 
through  liis  whole  mental  life,  obscured  it  may  be,  for  these 
patients  are  often  able  to  correct  and  conceal  their  insane  symp- 
toms, but  it  nevertheless  exists  and  only  requires  fricti(jn  to 
bring  it  to  the  surface.  The  general  intellectual  status  of  these 
patients,  though  rarely  of  a  high  order,  is  sufficient  to  keep 
the  delusion  under  check  for  practical  purposes  of  life.  While 
many  are  what  is  termed  crochety,  irritable  and  depressed,  yet 
the  symptom  of  the  typical  cases  of  this  disorder  is  of  the  fixed 
delusions.  These  patients  consider  themselves  either  the  victim 
of  a  plot  or  as  unjustly  deprived  of  certain  rights  and  position, 
or  as  narrowly  observed  by  other  delusions  of  persecution  are 
added  to  the  fixed  ideas  and  the  patient  becomes  sad,  thoughtful 
or  depressed  in  consequence  or  the  reverse  may  occur.  Because 
he  is  watched  and  made  the  subject  of  audible  comments  (hal- 
lucinatory or  delusional),  he  concludes  that  he  must  be  a 
person  of  some  importance.  Some  great  political  movement 
takes  place ;  he  throws  himself  into  it,  either  in  a  fixed  character 
that  he  has  already  constructed  for  himself,  or  with  the  vague 
idea  that  he  is  an  influential  personage.  He  seeks  interview's 
with  the  big  men  of  the  day.  accepts  the  common  courtesy 
shown  him  by  those  in  office  as  a  tribute  to  his  value,  is  rejected 
however,  and  then  judges  himself  to  be  the  victim  of  jealousy 
or  of  rival  cabals,  makes  intemperate  and  querulous  com- 
plaints to  higher  officials,  perhaps  makes  violent  attacks  upon 
them  and  being  incarcerated  in  jail  or  asylum  looks  upon  this 
as  the  end  of  a  long  series  of  persecutions  which  have  broken 
the  power  of  a  skilled  diplomatist,  a  capable  military  com- 
mander, a  prince  of  the  blood,  an  agent  of  a  camarilla,  a  para- 
mour of  some  exalted  personage  or  perchance  the  ^Messiah 
Himself.  All  through  this  train  of  ideas  there  runs  a  chain 
of  logic  and  inference  in  which  there  is  no  gap.  If  the  inference 
of  the  patient  were  based  on  correctly  observed  facts  and  prop- 
erly correlated  with  his  actual  surroundings  his  conclusions 
would  be   perfectly   correct.     For  years   and  years  many  such 

'"'  Spitzka,  St.  Louis  Clinical  Record,  1879-80. 
11 


146  IRREGULARITIES    OF    THE    TEETH. 

patients  exhibit  a  single  delusive  idea  as  the  only  prominent 
symptom.  There  is  hereditary  taint  in  most  of  these  subjects 
who  are  strange  in  disposition  from  infancy.  As  children  they 
frequently  shun  society  and  indulge  in  day-dreams.  Their  bodily 
growth  is  normal,  but  even  trifling  disease  takes  on  a  cerebral 
tinge.  They  may  show  talent  in  special  directions,  but  their 
intelligence  rarely  passes  out  of  the  puerile  stage.  They  often 
brood  over  a  feminine  ideal,  a  girl  who  has  never  encouraged 
them,  and  whom  they  persecute  with  absurd  plans  of  marriage. 

Connecting  the  paranoiac  with  the  moral  imbecile  are  the 
co-called  "reasoning  maniacs"  in  whom  the  intellectual  power 
is  less  than  either  that  of  the  moral  imbecile  or  of  the  paranoiac, 
twisted  though  the  intellect  of  the  latter  be.  Loquacious  or 
unusually  taciturn,  heedless  or  morbidly  cautious,  dreamers, 
wearisome  to  all  brought  in  contact  with  them,  capricious  and 
unmitigated  liars,  their  qualities  are  often  in  a  certain  manner 
brilliant,  but  are  entirely  without  solidity  or  depth.  Sharpness 
and  cunning  are  not  often  wanting,  especially  for  little  things 
and  insignificant  and,  quick  comprehension,  they  readily  appro- 
priate the  ideas  of  others,  developing  or  transforming  them 
and  giving  them  the  stamp  of  their  own  individuality.  But  the 
creative  force  is  not  there  and  they  rarely  possess  enough 
mental  vigor  to  get  their  own  living.  Passing  without  the 
slightest  transition  from  one  extreme  to  another  they  felicitate 
themselves  to-day  on  an  event  which  they  sneered  at  the  night 
before.  In  the  course  of  a  single  second  they  change  their 
opinion  of  persons  and  things;  novelty  captivates  and  wearies 
them  almost  at  the  same  time.  They  sell  for  insignificant  sums 
things  they  have  just  bought,  in  order  to  buy  others  which,  in 
their  turn,  will  be  subject  to  like  treatment,  and,  strange  to  say, 
before  possessing  these  objects  they  covet  them  with  a  degree 
of  ardor  only  equaled  by  the  eagerness  they  exhibit  to  get 
rid  of  them  as  soon  as  they  become  their  own.  To  see,  to 
desire  and  to  become  indififerent  to  these  stages  which  follow 
each  other  with  astonishing  rapidity. 

The  intense  egotism  of  these  persons  makes  them,  as  W. 
A.  Hammond  has  shown,  utterly  regardless  of  the  feelings  and 
rights  of  others.     Everybody  and  everything  must  give  way  to 


INTELLECTUAL    AND    MORAL    DEFECTS.  147 

them.  Their  comfort  and  convenience  are  to  be  secured,  though 
everyone  else  is  made  uncomfortable  and  unhappy;  and  some- 
times they  display  positive  cruelty  in  their  treatment  of  persons 
who  come  in  contact  with  them.  This  tendency  is  especially 
seen  in  their  relations  with  the  lower  animals. 

Another  manifestation  of  their  intense  egotism  is  their  entire 
lack  of  appreciation  of  kindness  done  them  or  benefits  of  which 
they  have  been  the  recipients.  They  look  upon  these  as  so  many 
rights  to  which  they  are  justly  entitled  and  which  in  the  bestowal 
are  more  serviceable  to  the  giver  than  the  receiver.  They  are 
hence  ungrateful  and  abusive  to  those  who  have  served  them, 
insolent,  arrogant  and  shamelessly  hardened  in  their  conduct 
toward  them.  At  the  same  time,  if  advantages  are  yet  to  be 
gained,  they  are  sycophantic  to  nauseousness  in  their  deport- 
ment toward  those  from  whom  the  favors  are  to  come.  The 
egotism  of  these  people  is  unmarred  by  the  trace  of  modesty 
in  obtruding  themselves  and  their  alleged  good  qualities  upon 
the  public  at  every  opportunity.  They  boast  of  their  genius, 
their  righteousness,  their  goodness  of  heart,  their  high  sense  of 
honor,  their  learning,  and  other  qualities  and  acquirements, 
and  this  when  they  are  perfectly  aware  they  are  common-place, 
irreligious,  cruel  and  vindictive,  utterly  devoid  of  every  chival- 
rous feeling  and  saturated  with  ignorance.  They  know  that  in 
their  railings  they  are  attempting  to  impose  upon  those  whom 
they  address  and  subsequently  will  even  brag  of  their  success. 

It  is  no  uncommon  thing  for  the  reasoning  maniac  still 
influenced  by  his  supreme  egotism  and  desire  for  notoriety  to 
attempt  the  part  of  reformer.  Generally  he  selects  a  practice 
or  custom  in  which  there  is  really  no  abuse.  His  energy  and 
the  logical  manner  in  which  he  presents  his  views,  based  as  they 
often  are  on  cases  and  statistics,  impose  on  many  people  who 
eagerly  adopt  him  as  a  genuine  overthrower  of  a  vicious  or 
degrading  measure.  Even  when  his  hypocrisy  and  falsehood  are 
exposed  he  continues  his  attempts  at  imposition  and  when  the 
strong  arm  of  the  law  is  laid  upon  him  he  prates  of  the  ingrati- 
tude of  those  he  has  been  endeavoring  to  assist  and  of  the 
unselfishness  and   purity  of  his  own  motives. 


CHAPTER    XVI. 


INTER-OPERATIONS   OF    CAUSES    AND    PREDISPO- 
SITIONS. 

From  the  previous  chapters,  it  will  be  seen  that  forces  tend- 
ing to  change  in  an  existing  organism,  act  in  various  ways  as  part 
of  the  environment  of  the  individual,  and  through  its  influence 
on  him  produce  changes  in  the  complex  union  of  checks,  bal- 
ances, forces  and  material  bases  which  constitute  the  human 
organism  as  inherited.  Of  necessity  any  change  in  this  complex 
unity  being  unusual  must  be  abnormal  so  far  as  the  organism 
existing  prior  to  the  change  is  concerned.  The  question  whether 
such  abnormality  be  of  benefit  or  injury  is  another  matter. 

As  Virchow^  remarked  seven  years  ago:  Transformation,  a 
metaplasia,  a  change  from  one  species  into  another,  whether  in 
individual  animals  or  plants  or  individuals  or  their  tissues,  cannot 
take  place  without  anomaly;  for  if  no  anomaly  appear  this  new 
departure  is  impossible.  The  physiologic  norm  hitherto  sub- 
sisting is  changed,  and  this  change  cannot  well  be  called  anything 
but  an  anomaly.  In  former  days  an  anomaly  was  called  pathos 
and  in  this  sense  every  departure  from  the  norm  is  a  pathologic 
event.  If  such  pathologic  event  be  ascertained,  this  forces  inves- 
tigation as  to  what  pathos  was  the  special  cause  of  it.  This 
cause  may  be,  for  example,  an  external  force  or  a  chemical 
substance  or  a  physical  agent  producing  in  the  normal  condition 
of  the  body  a  change,  an  anomaly  (pathos).  This  can  become 
hereditary  under  some  circumstances  and  then  may  become  a 
foundation  for  certain  light  hereditary  characteristics  propo- 
gated  in  a  family.  In  themselves  these  belong  to  pathology,  even 
though  they  produce  no  injury.  Pathologic  does  not  mean 
harmful,  nor  does  it  indicate  disease.  Disease  in  Greek  is 
nosos  and  it  is  nosology  that  is  concerned  with  disease.  The 
pathologic  tmder  some  circumstances  may  be  of  advantage  to 
its  inheritor. 

1  Correspondenz-blatt  v.  Deutsch.     Gesellschaft  f.  Anth.,  1894. 

148 


INTER-OPERATIONS    OF    CAUSES    AND    PREDISPOSITIONS.         149 

From  this  standpoint  it  is  obvious  that  the  fact  whether  a 
given  change  in  the  organism  shall  prove  a  defect  or  not  is 
determined  by  the  conditions  of  periods  of  stress  during  intra 
and  extra-uterine  life.  According  to  general  observations  made 
by  Weismann  and  others  any  condition  affecting  the  indi- 
vidual must  in  some  way  affect  the  organism  as  a  whole  in  order 
to  survive  these  periods  of  stress. 

In  dealing  with  the  origin  of  any  defect  or  gain  in  the  animal 
organism,  several  factors  must  be  taken  into  account,  indepen- 
dently of  the  simple  element  of  heredity.  Heredity,  moreover, 
is  not  the  uncomplicated  agent  which  is  usually  regarded  as  pro- 
ducing certain  effects.  In  dealing  with  heredity  the  influence 
of  the  inter-uterine  stress  on  the  foetus  must  be  determined. 
Unusual  strain  of  any  kind  upon  the  mother  during  gestation 
may  unfavorably  effect  the  foetus.  The  healthier  the  ancestry 
the  less  liable  the  mother  would  be  to  ill  effect  from  such  strain. 
On  the  other  hand  unusually  favorable  conditions  during  gesta- 
tion may  correct  defects  observable  at  previous  pregnancies. 
Periods  of  stress  are  constituted  by  the  different  periods  of 
embryonic  development  as  well  as  by  those  extra-uterine.  Even 
sex  is  determined  by  conditions  of  stress  after  a  certain  period. 
Poor  maternal  nutrition  will  determine  an  excess  of  males,  while 
good  will  determine  an  excess  of  females.  Arrests  at  certain 
periods  of  intra-uterine  life  will  procfuce  prematurely  senile 
states ;  since,  as  already  stated,  there  is  a  period  in  intra-uterine 
life  during  which  the  foetus  wavers  between  the  senile  appear- 
ance of  adult  anthropoid  apes  and  that  of  mankind  in  youth. 
This  intra-uterine  stress  may  be  an  expression  of  the  general 
nervous  exhaustion  of  the  mother  Avhich  first  affecting  checking 
influences  of  the  central  nervous  system  finally  leads  to 
unchecked  excessive  nervous  action  of  the  part  of  the  local 
nervous  systems  of  the  organs  leading  secondarily  to  exhaustion 
of  these.  In  consequence  the  mother  is  unable  either  to  manu- 
facture proper  elements  of  nutrition  or  to  excrete  waste  material. 
The  foetus  thereby,  starved  and  poisoned,  fails  to  pass  through 
the  periods  of  stress  in  a  complete  well-balanced  manner.  The 
stress  in  these  periods  is  strongest  on  those  structures  which 
are  transitory  and  variable  in  type.    This  influence  may  further- 


150  IRREGULARITIES    OF    THE    TEETH. 

more  be  exerted  on  the  foetus  through  stress,  mental  or  other- 
wise, of  the  mother.  The  human  foetus  exhibits,  as  elsewhere 
shown,  very  decided  reaction  to  sensory  impressions  on  the 
mother. 

At  every  one  of  these  periods,  the  forces  which  determine 
the  variations  of  the  individual  from  the  race  and  those  which 
tend  to  preserve  the  race  type  are  in  constant  conflict.  Con- 
ditions affecting  nutrition  of  the  ovum  prior  to  fecundation  (as 
derived  from  the  mother)  and  conditions  affecting  the  fecun- 
dation of  the  ovum  (as  derived  from  the  father),  as  well  as 
those  derived  from  both  father  and  mother  after  fecundation, 
will  determine  whether  or  not  the  foetus  shall  pass  through  the 
complete  embryologic  evolution  determined  by  the  race  type 
and,  whether  or  not  individual  variation  present  in  the  parents 
shall  be  transmitted  successfully  through  these  periods  of  stress. 

While  all  of  the  factors  enumerated,  enter  into  the  cause  of 
jaw  degeneration,  one  of  the  great  factors  is  the  extraction 
of  the  temporary  and  permanent  teeth.  In  no  country  is  this 
pernicious  habit  so  marked  as  abroad.  Constant  extraction  of 
the  teeth  produce  variations  (arrest  of  development)  which  are 
transmitted  from  one  generation  to  another.  In  the  evolution 
of  the  jaws,  nothing  could  be  easier  accomplished  than  this. 
One  period  of  stress  is  marked  by  eruption  of  the  temporary 
and  the  next  period  of  stress  by  the  eruption  of  the  second 
set.  The  first  permanent  molar  is  the  first  tooth  to  erupt  in 
the  permanent  set.  It  is  situated  in  the  center  of  the  jaw. 
Permanent  teeth  erupt  anterior  and  posterior  to  this  tooth. 
This  tooth,  because  it  is  larger,  requires  more  room.  The  first 
molar  is  the  first  tooth  to  decay.  As  soon  as  it  aches  it  is 
removed.  When  the  other  permanent  teeth  erupt  they  move 
forward  and  fill  the  space  made  vacant  by  the  lost  first  molar. 
Since,  therefore,  the  jaw  expands  and  grows  only  for  the  pur- 
pose of  containing  the  teeth,  if  they  be  not  present  the  jaw- 
ceases  to  develop.  What  is  true  of  the  first  molar  is  also  true 
of  the  other  teeth.  In  many  countries  one  tooth  after  another 
is  sacrificed  as  soon  as  it  begins  to  ache.  Not  infrequently 
whole  sets  of  teeth  are  removed  in  young  Hfe  before  the  jaws 
have   fully    developed.     The   habit   of   early   extraction   of   the 


INTKR-Ol'ERATIONS    OF    CAUSES    AND    PREDISPOSITIONS.         151 

temporary  and  permanent  teeth  from  one  generation  to  another 
causes  arrest  of  development  in  two  ways.  First,  through  the 
inheritance  of  acquired  defects ;  second,  by  natural  selection. 
Since  the  jaws  and  teeth  are  so  unstable  in  their  development 
they  are  easily  affected. 

The  influence  of  the  complex  sociologic  state  civilization, 
while  not  having  the  malign  influence  ascribed  to  it,  has,  by  its 
economy  as  regards  food  production  and  preparation,  lessened 
markedly  the  functions  of  the  jaws  and  teeth.  Food  no  longer 
needs  the  grinding  and  tearing  required  from  primitive  man 
or  even  types  as  high  as  the  "pile  dwellers,"  whose  food  is 
still  to  be  found  even  to  coarse  breads  and  cakes.  Under  the 
law  of  economy  of  growth,  lessened  muscular  action  leads  to 
lessened  blood  supply.  Lessened  blood  supply  produces  con- 
ditions in  the  offspring  tending  to  under  nutrition  of  certain 
parts  for  the  benefit  of  the  body  as  a  whole  and  to  diminish  in 
size  of  unused  parts.  As  the  jaws,  alveolar  process  and  teeth 
are  comparatively  unstable  in  all  mammals,  these  of  necessity 
would  be  peculiarly  affected  by  disuse.  A  very  similar  evolu- 
tion is  occurring  in  the  dog  in  whom  domestication  plays  the 
part  of  civilization  and  who  from  a  carnivore  has  become  an 
omnivore.  In  the  mongrel  dog,  race  admixture  and  other  fac- 
tors producing  change  in  man  are  to  be  found.  In  him, 
peculiarly,  domestication  would  play  the  part  of  civilization. 
In  him  jaw  and  tooth  irregularities  ascribed  to  other  causes 
occur.  Facility  for  producing  food  under  domestication  has 
played  a  part.  Disuse  of  the  jaw  as  a  weapon  by  man  has  done 
its  share  in  the  changes  comparatively  early  in  development. 
To  a  certain  extent  this  last  change  is  still  going  on  in  the 
dog.  In  cases  predisposed  to  advance  in  evolution,  irregular- 
ities of  beneficial  type  would  occur  with  great  facility.  In 
cases  predisposed  in  the  opposite  direction  changes  would  result 
of  opposite  effect. 

As  (Table  XXXIII)  shows  the  irregularities  of  the  jaws  and 
teeth  increase  proportionately  westward  from  Greece  to  the 
British  Isles,  the  rate  in  the  British  Isles  being  greatest.  Greece, 
however,  no  longer  contains  the  race  which  so  long  dominated 
the  world  intellectually.     The  people  are  a  mixed  Slavo-Mon- 


152  IKREGULARITIF.S    OF    THE    TEETH. 

goloid  race  who  speak  Greek.  Furthermore  as  the  correctional 
charitable  and  hospital  arrangements  are  primitive  the  defective 
classes  are  not  accumulated.  Under  such  conditions  a  certain 
seeming  decrease  in  stigmata  of  degeneracy  must  result.  This, 
however,  would  extend  more  to  deeper  stigmata  than  to  those 
of  the  jaws  and  teeth.  As  tables  show  degenerate  jaws  and 
teeth  are  commonest  next  to  the  English  speaking  people  among 
the  Scandinavian  speaking.  As  both  have  passed  through  very 
similar  phases  of  race  evolution  and  both  contain  at  bottom 
the  same  race  elements,  this  was  to  have  been  expected.  The 
general  result  of  this  table  shows,  as  I  have  pointed  out  some 
years  ago,  that  the  struggle  for  existence  between  the  organs, 
dependent  on  race  evolution  and  race  admixture,  has  resulted 
in  the  higher  races  in  the  triumph  of  the  brain  and  skull  at 
the  expense  of  the  face,  hence,  the  higher  the  intellectuality  the 
greater  the  tendency  to  local  degeneracy  of  the  face,  jaws  and 
teeth. 


ciiAr'ri':R  xvii. 


DEX'KLOPMENTAL  NEUROSES  C)E  THE  FACE. 

To  tlie  great  anatomist,  Camper,  belongs  llic  credit  of  study- 
ing the  human  face  from  the  scientific  standpoint.  This  great 
anatomist  gave  his  name  to  the  facial  angle  which,  even  up  to 
the  present  day,  serves  as  a  standard  by  which  to  judge  the 
rank  of  the  human  face  in  comparison  with  the  lower  forms  of 
animals.  In  one  of  his  works  he  gives  (Fig.  36)  "physical 
observation  on  the  difference  of  the  feature  of  the  face  considered 
in  profile,  as  the  heads  of  apes,  orang-outangs,  of  negroes  and 
other  peoples,  tracing  up  to  antique  heads."  "You  will  be 
astonished,"  he  says,  "to  find  among  my  first  plates  two  heads 
of  apes,  then  of  a  negro  and  then  one  of  a  camel." 


Fig.  36. 

Showing  the  gradual  retreat  of  the  jaws  in  passing  from  the  lower  to  higher  types  of 
face.     (Rimmer.    Art  Anatomy,  London,  1884.) 

The  facial  angle  of  Camper,  Cuvier,  Cloquets,  Jacquarts, 
the  Munich-Frankfort  Angle  and  that  of  Topinard  involve 
merely  the  bones  of  the  face,  not  the  inferior  maxilla.  Most 
authors  dealing  with  prognathism  and  orthognathism  refer 
merely  to  the  skull  including  the  superior  maxilla.  Medical 
specialists  must,  however,  include  the  inferior  maxilla  in  the 
outline  in  order  to  show  what  may  or  may  not  be  required  in 
improving  the  jaws  and  teeth.  In  studies  of  the  etiology  of 
irregularities  of  the  jaws  and  teeth,  I  have  simply  extended 
the  facial  line  downwards  below  the  lower  jaw.  Fig.  37.  An 
imaginary  perpendicular  line  dropped  from  the  superciliary  ridge 
below  the  lower  jaw  will  decide  whether  the  jaws  be  prog- 
nathous or  orthognathous. 

153 


154  IREEGULARITIES    OF    THE    TEETH. 

During  a  trip  to  Europe  in  1897,  observations  were  made  in 
both  the  British  Isles  and  the  Continent  as  to  the  facial  angle. 
In  most  countries  casual  examination  was  made,  but  where 
marked  deformities  presented  themselves  more  careful  obser- 
vations were  conducted.  The  soldiers,  police  and  cabmen,  as 
a  rule,  as  well  as  citizens  were  observed.  In  Stockholm,  on 
examination  of  5,000  people,  the  following  results  were  obtained, 
two  per  cent  outside  the  perpendicular,  14.70  per  cent  on  the 
line,  and  83.30  inside  the  line.  In  London,  examination  of  the 
faces  of  10,000  passers-by  revealed  4.13  outside  the  line,  12.87 
on  the  line,  and  83.00  inside  of  the  line.  In  an  examination  of 
3,000  English  school  children  (about  ten  years  of  age),  93 
per  cent  possessed  jaws  inside  of  the  perpendicular  line.    Prog- 


Fig-.  37. 

nathism  elsewhere  in  Europe  furnishes  an  offset  sufficient  to 
interfere  with  the  production  of  marked  irregularities. 

In  comparison  with  these  results  are  those  obtained  in 
Baltimore  under  the  supervision  of  B.  Holly  Smith,  by  William 
C.  Palmer ;  in  Chicago  Robert  Keith,  under  my  own  super- 
vision. Those  made  in  Baltimore  showed  8  per  cent  outside 
the  line;  36.5  on  the  line,  and  55.5  inside  the  line.  Those  in 
Chicago  were  4.6  outside  the  line;  14.6  on  the  line,  and  80.7 
inside  of  the  line. 

The  rapidity  of  evolution  of  the  facial  angle  is  shown  in  the 
faces  of  American  negroes.  On  examination  of  357  by  William 
Ernest  Walker  in  New  Orleans,  protrusion  was  found  in  97.5 ; 
on  the  line  2.5  per  cent.  On  examination  by  Arthur  R.  Dray, 
of  686  in  Philadelphia,  83.57  per  cent  were  found  to  present  pro- 
trusion, and  15.95  on  the  line;  1.13  recession.    On  examination 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE.  155 

of  1,085  in  Chicago,  51.06  presented  protrusion;  31.08  per  cent 
on  the  line  and  16.6  recession.  Examination  by  Eugene  F. 
O'Neill,  of  negroes  in  Boston  showed  that  of  1,000,  454  or  45.4 
per  cent  were  protrusion,  395  or  39.5  per  cent  on  the  line  and 
151  or  15. 1  per  cent  receding.  O'Neill  says,  "many  of  the  faces 
classed  as  protruding  have  a  marked  protrusion  of  both  jaws, 
but  have  the  symphysis  well  back  of  the  vertical  plane.  In 
fully  one-half  of  the  cases  enumerated  as  protruding,  the  pro- 
trusion is  comparatively  slight  and  a  smaller  number  has  the 
typically  protruding  angle  which  is  shown  in  the  diagram. 

Evolution  of  the  jaws  in  their  recession  is  hence  more  rapid 
than  the  teeth  and  alveolar  process.  The  teeth  do  not  grow 
small  in  proportion  to  the  jaws,  wherefore  they  retain  their 
contour.  Northern  and  older  negro  families  from  race  admix- 
ture have  less  protrusion  and  more  recession  than  the  Southern 
negro.  Ward  has  shown  that  absolute  size  of  the  lower  jaw 
is  greater  in  savages:  "Of  nine  aborigines,  including  seven  North 
American  Indians,  one  African  and  one  American  negro,  six 
Malays  and  five  Australians,  all  with  beautifully  perfect  teeth, 
the  mean  weight  of  the  jaw  was  102.4  grams.  Of  eighteen 
white  males  the  mean  weight  of  the  jaw  was  only  83.4  grams. 
Yet  the  weight  of  the  skull  was  nearly  alike  in  both  classes, 
being  690.9  grams  for  the  aborigines  as  against  680.5  ^^r  the 
whites.  The  weight  of  the  lower  jaw  compared  with  that  of 
the  cranium,  or  the  Cranio-Mandibular  Index,  as  I  have  termed 
it,  is  15.6  for  aboriginal  men  as  against  12.16  for  white  men. 
It  is  46.2  for  anthropoid  apes,  our  nearest  living  relatives 
among  mammals. 

Does  not  this  prove  a  progressive  degeneracy  in  the  mas- 
ticatory apparatus  of  civilized  man?"^ 

Examination  of  the  heads  of  eighteen  negroes,  taken  at  ran- 
dom, revealed  that  five  had  a  cephalic  index  below  seventy,  six 
between  seventy  and  eighty,  and  seven  above  eighty.  These 
results  tend  to  show  that  mesocephalic  skull  types  are  increasing 
in  numbers  among  American  negroes  and  that  the  jaws  are 
gradually    shortening.      Dolichocephaly    is    decreasing.      Upon 

lA  Cranio-Mandibular  Index.  Proceedings  of  the  Association  of 
Americaji  Anatomists,  1897. 


156  IRREGULARITIES    OF    THE    TEETH. 

examination  of  about  two  thousand  Chicago  negroes,  I  was 
able  to  find  but  six  cases  of  doUchocephaly.  Even  allowing 
for  slight  admixture  of  brachycephaly  from  the  negro  races 
themselves,  it  is  obvious  that  changes  in  climate  and  admixture 
with  the  Indian  and  Caucasic  races  in  America  have  completely 
changed  the  shape  of  the  head  as  well  as  the  physicjue  of  the 
negro. 

The  persistent  prognathism  of  the  negro  is  due  in  a  great 
measure  to  excessive  development  of  the  inferior  maxilla.  The 
rami  and  body  of  the  lower  jaw,  also  the  muscles  of  mastication, 
are  verv  large  and  massive  compared  with  those  of  the  white ; 
upon  the  other  hand  the  superior  maxilla  is  smaller  and  more 
delicate.     The  constant  force  of  the  larger  lower  jaw  upon  the 


Fig.  38. 

upper,  causes  the  alveolar  process  to  be  carried  forward  and 
upward,  thus  producing  prognathism.  American  negroes 
to-day  (especially  those  living  in  the  Northern  States)  possess 
jaws  not  unlike  those  of  the  Caucasic  races.  The  zygomatic 
arches  are  smaller,  the  muscles  less  dense  and  rigid,  the  lower 
jaw  massive  and  orthognathism  in  lieu  of  prognathism  occurs 
to  a  certain  extent.  This  is  brought  about  by  the  arrest  of 
development  of  the  muscles  and  body  of  the  lower  jaw,  due  to 
change  of  climate  and  of  soil  and  race  admixture. 

Since  Camper's  time  scientists  have  been  studying  the  pecu- 
liar forms  and  shapes  of  the  face  more  extended. 

As  I  have  pointed  out  elsewhere,  the  degeneracies  imply 
deficiencies  in  constitution  not  only  in  mental,  moral,  but  also 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE,  157 

in  neurosal  and  other  directions.  These  deficiencies,  as  has 
been  shown  in  the  discussion  of  neuroticism,  are  often  expres- 
sions of  imperfect  advance  evincing  itself  in  the  unequal  balance 
between  hypertrophy,  excessive  development,  statu  quo  and 
atrophy.  This  is  especially  illustrated  in  the  following  cases 
showing  protrusion  and  arrest  of  development  of  the  face  and 
jaws.  In  the  first  case  the  figure  given  is  a  correct  outline  of 
the  patient  described  albeit  the  figure  is  taken  from  Tarnowsky. 
Casei.  Fig.  38.  The  patient  is  a  school  teacher,  thirty-seven 
vears  of  age.   of  nervous  temperament,  bright,  and  well  edu- 


Fig.  39. 

cated.  Father  is  a  periodical  drunkard.  The  paternal  grand- 
mother died  of  consumption.  One  of  the  paternal  cousins 
committed  suicide,  and  another  became  insane.  A  sister  of  this 
cousin  hanged  herself.  The  grandmother  on  the  mother's  side 
became  insane  and  a  grandaunt  committed  suicide.  The  patient 
was  born  in  the  East,  but  came  West  on  account  of  a  tendency 
to  consumption.  The  forehead  is  very  prominent,  with  a  marked 
depression  at  the  bridge  of  the  nose.  The  nose  is  undeveloped 
and  has  the  appearance  of  falling  into  the  face.  Hypertrophy 
of  the  mucous  membrane  and  bones  of  the  nose  require  her  to 
breathe  through  the  mouth.     The  chest  is  undeveloped.     She 


158 


IRREGULARITIES    OF    THE    TEETH. 


is  round-shouldered.  The  jaws  and  chin  are  fairly  well  devel- 
oped. The  alveolar  process,  although  small  for  the  body,  has 
normal  dental  arches.  Width  outside  first  permanent  molar, 
2;  outside  second  bicuspid,  1.90;  width  of  vault,  1.60;  height 
of  vault,  .62.  Third  molar  not  present  and  teeth  small.  Ordinary 
causes  of  deformity  are  hence  absent. 

Case  2,  Fig.  39,  is  a  twenty-three  year  old  man,  whose 
mother  was  epileptic  and  died  in  the  status  epilepticus.  The 
father  died  of  locomotor  ataxia.  The  lower  jaw  seems  prog- 
nathous.    The  face  from  the  upper  border  of  the  lower  teeth 


Fig.  40. 

to  the  superciliary  ridge  is  markedly  concave.  The  superior 
maxillary  bones  as  well  as  the  zygomse  are  arrested  in  their 
development.  The  eyes  are  quite  deeply  set  in  the  head.  Fore- 
head narrow  and  quite  prominent.  There  is  total  collapse  of 
the  walls  of  the  nose,  difficuhy  in  breathing,  hypertrophy  of  the 
turbinated  bones  and  mucous  membrane,  adenoid  growth  and 
mouth-breathing.  In  this  case  the  lower  jaw  is  not  excessively 
developed  since  the  teeth,  which  are  not  large,  just  fill  the 
space,  while  the  incisors  do  not  protrude  and  the  third  molars 
are  in  place.     The  upper  jaw,  however,  is  greatly  arrested  in 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE. 


159 


development.  The  third  molars  are  not  present.  They  could 
not  erupt  if  they  were  there  for  want  of  space.  The  left  first 
bicuspid  has  been  extracted  allowing  spaces  to  occur  between 
the  incisors.  In  order  that  the  teeth  may  all  come  into  position, 
the  anterior  alveolar  process  has  been  pushed  forward  .60  of 
an  incli.  If  the  bones  of  the  face  had  developed,  the  lower  jaw 
would  have  appeared  to  a  better  advantage.  There  is  arrest 
of  development  of  the  superior  maxillse,  zygomae  and  nasal 
bones  with  a  normal  lower  jaw.  A  marked  ridge  extends  the 
entire  length  of  the  vault  at  the  suture.     The  distance  outside 


Fig.  41. 

of  first  molar  is  2;  outsifle  of  second  bicuspid,  1.75;  width  of 
vault  betwen  second  bicuspid,  i  ;  height  of  vault,  .62.  The  chest 
walls  are  very  contracted,  the  shoulders  considerably  stooped 
and  the  chest  expansion  very  slight. 

Case  3.  Fig.  40.  A  young  man  twenty  years  of  age  is  mark- 
edly neurotic.  Bookkeeper,  but  is  above  the  average  in  intellect. 
The  appearance  of  the  face  and  jaws  are  about  the  same  as  Fig. 
39,  with  this  exception,  that  the  zygomae  are  a  little  more  devel- 
oped. Width  outside  first  permanent  molars,  2;  outside  second 
bicuspids,  1.72;  between  second  bicuspid,  1.02;  height  of  vault, 
.59.     There  is  total  collapse  of  the  nasal  openings,  causing  him 


160 


IRREGULARITIES    OF    THE    TEETH. 


to  breathe  through  the  mouth  since  he  was  four  years  of  age ; 
the  two  sides  of  the  left  nostril  approximate,  while  the  turbin- 
ated bones  upon  the  right  side  owing  to  hypertrophy  fill  the 
space.  A  thickening  of  the  mucous  membrane  throughout  the 
anterior  and  posterior  nares  is  also  observed.  This  picture  was 
taken  two  years  after  the  contour  of  the  teeth  had  been  restored ; 
therefore,  the  upper  lip  is  more  pronounced  than  in  Fig.  39. 
There  is,  how^ever,  a  marked  concavity  of  the  face  between  the 
zygomae  and  the  upper  jaw ;  the  upper  lip  was  depressed  as  in 
Fig.  39  before  the  operation.    The  chest  is  very  contracted,  with 


Fig.  42. 

very  little  or  no  expansion  on  inhalation.  The  father  has  well 
formed  jaws.  The  mother  has  marked  arrest  of  development  of 
the  upper  jaw. 

■  Case  4,  Fig.  41,  is  a  married  stenographer  of  excellent  habits 
and  good  principle,  steady  and  a  hard  worker.  When  a  small 
child  he  was.  a  chubby,  fat  boy.  His  father  and  uncle  possess 
this  arrest  of  development.  This  gentleman  has  two  sisters  and 
a  brother ;  one  of  the  sisters  has  the  deformity  and  a  brother 
slightly.  The  cheek  bones  are  prominent,  there  is  arrest  of  devel- 
opment of  the  superior  maxillary  bones,  a  well  formed  and  reg- 
ular alveolar  process  and  dental  arch,  fine  teeth  and  full  normal 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE. 


161 


lower  jaw.  Width  outside  first  permanent  molar,  2.25  ;  outside 
second  bicuspid,  i.yo;  width  of  vault,  1.26;  height  of  vault,  .52. 
With  such  a  history  no  one  could  dispute  that  this  deformity  was 
a  clear  case  of  direct  heredity.  The  chest  is  a  little  broader  than 
the  other  two,  but  there  is  the  same  weakness  of  voice. 

Case  5,  Fig.  42.  This  patient  was  above  the  average  in  intel- 
lect. Father,  mother,  brother  and  sisters  all  living;  no  untoward 
family  history.  He  was  a  marked  neurotic ;  a  fair  dentist,  but 
liked  medicine  better  and  would  have  made  a  good  practitioner. 
He  was  a  good  musician  ;  could  [jlay  several  instruments  but  pre- 


^ 

1^  ■         Jt'^'' 

^^y 

^Fk 

_  ,^ 

Bk»:i 

Fig.  43. 


ferred  the  cornet.  Arrest  of  development  of  the  upper  jaw 
occurred  at  or  about  the  sixth  year.  As  the  teeth  were  crowded, 
with  considerable  protrusion  of  the  anterior  teeth  and. alveolar 
process,  there  was  a  pronounced  semi-saddle-shaped  jaw.  Was 
strictly  temperate.  Died  at  the  age  of  twenty-six  of  paretic  de- 
mentia (of  the  acquired  type).  Width  outside  first  molar, 
2.03;  outside  second  bicuspid,  1.90;  inside,  1.60;  height  of 
vault,  .75. 

Case  6,  Fig.  43.     Aged  forty-one  years;  married.     Born  in 
England  of  English  parents.     Father,  sailor,  died  of  peritonitis ; 
12 


162  IRREGULARITIES    OF    THE    TEETH. 

mother,  heart  rheumatism.  He  came  to  America  fifteen  years 
ago.  He  is  in  the  harness  business  and  of  excellent  habits.  The 
patient  is  a  neurotic.  The  bones  of  the  face  are  arrested  in  their 
development.  The  line  drawn  from  the  bridge  of  the  nose  to 
a  point  opposite  second  molar  produces  a  marked  depression. 
There  is  a  marked  arrest  of  the  lower  jaw.  The  anterior  surface 
of  the  lower  centrals  occlude  at  the  first  bicuspid ;  this  gives  the 
appearance  of  no  chin.  All  the  teeth  are  present  in  the  upper 
jaw,  the  width  of  which  is  1.75  outside  first  permanent  molar;  it 
is  also  a  saddle-shaped  arch.  In  order  that  the  jaws  may  accom- 
modate all  the  teeth,  they  have  pushed  the  alveolar  process  and 
jaw  bones  forward.    This  man  has  always  been  a  mouth  breather. 


FiK.  44. 

The  mouth,  therefore,  has  always  been  open;  as  a  result  the 
teeth  and  alveolar  process  have  grown  downward.  Although 
the  lips  are  long  enough,  he  cannot  close  them,  owing  to  the 
excessive  development  of  the  alveolar  process.  The  alveolar 
process  and  teeth  of  the  lower  jaw  are  normal  in  development. 
The  height  of  vault  is  .82  (this  is  an  unusually  high  vault).  The 
alveolar  process  is  large  and  thin.  The  excessive  development 
of  the  alveolar  process  nicely  illustrates  how  high  vaults  are 
produced.  The  cheek  bones  are  also  arrested,  but  not  to  the 
extent  of  some.  The  eyes  are  deeply  set;  the  superciliary  ridges 
very  prominent.  The  nose  is  very  long  and  thin;  the  sides  of 
the  nose  approximate  and  there  is  a  marked  thickening  of  the 
mucous  membrane ;    nose  breathing  is  impossible ;  the  chest  is 


DEVELOPMKNTAL    NKUROSKS    OF    THE    KACE. 


103 


contracted  and  the  nioiitli  is  continually  open.  The  iiead  is  sub- 
microcephalic ;  the  forehead  low ;  the  posterior  part  of  the  head 
is  very  prominent ;  the  ears  are  large. 

Case  7,  Fig.  44.  Twenty-nine  years  of  age.  Her  father  is 
now  suffering  from  paralysis.  The  patient  is  a  neurotic.  She 
is  a  fine  musician  and  artist  and  a  brilHant  conversationalist.  Jaw- 
bones proper  are  well  developed.  The  rami  are  excessively 
developed,  but  the  teeth  and  alveolar  process  are  undeveloped. 
There  is  very  Httle  enamel  upon  the  teeth,  and  what  remains 
can  be  scraped  oflf  like  horn.    The  crowns  of  the  teeth  are  worn 


Fig.  4.5. 


away  one-half  their  length.  Width  of  the  jaw  outside  first  molar, 
2.25;  outside  second  bicuspid,  2;  width  of  vault,  1.50;  height 
of  vault,  .50.  She  is  unable  to  bring  the  teeth  together  and  there- 
fore cannot  masticate  her  food.  To  compensate  for  this  she  does 
her  chewing  with  her  tongue  and  the  roof  of  her  mouth,  on 
account  of  wbicn  ler  tongue  has  become  hypertrophied  to  such 
an  extent  th  it  the  jaw  has  been  widened  by  the  lateral  pressure 
upon  the  teeth.  With  an  effort  she  can  bring  her  jaws  together, 
whif^h  makes  her  pout  and  the  chin  protrude,  making  her 
resemble  an  old  woman.    In  order  to  meet  this  deficiency  crowns 


164 


IRREGUI.ARITIES    OF    THE    TEETH. 


were  placed  upon  all  her  teeth,  which  had  the  effect  of  bringing 
her  jaws  at  rest  in  the  proper  positon. 

Case  8,  Fig.  45.  This  patient  is  eight  years  of  age.  His 
father  and  mother  are  Scotch  and  are  cousins.  He  has  arrested 
hydrocephalus  with  resultant  macrocephalic  head.  He  is  about 
the  average  in  intellect.  The  first  permanent  molars  have  erupted 
and  the  central  incisors  are  just  coming  through.  It  is  early  yet 
to  decide  just  what  deformity  will  be  produced,  because  the 
permanent  teeth  are  not  far  enough  advanced.  A  saddle  or 
V-shaped  is  sure  to  follow,  because  there  is  not  room  for  the 


Fig.  46. 


cuspids  and  bicuspids  to  erupt.  Arrest  of  development  of  the 
lower  jaw  is  quite  noticeable  at  this  early  age.  There  is  consid- 
erable hypertrophy  of  the  superior  alveolar  process  now.  Width 
outside  first  molar,  2 ;   height  of  vault,  .50. 

Case  9,  Fig.  46.  This  girl  is  a  fourteen-year-old  neurotic. 
Father  and  mother  are  living.  The  upper  jaw  and  face  are  very 
much  undeveloped.  The  dental  arch  was  V-shaped  and  the 
teeth  very  irregular.  This  picture  was  taken  after  the  teeth 
were  regulated.  The  upper  dental  arch  was  spread  .62.  The 
face,  therefore,  is  fuller  in  every  direction  and  appears  at  a  better 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE. 


165 


advantage  than  it  would  otherwise.  She  is  very  bright  and  a 
fine  reader.  The  jaw  became  arrested  at  the  sixth  year.  Width 
outside  first  permanent  molar,  1.75;  outside  second  bicuspid, 
1.50;  width  of  vault,  .84;  height  of  vault,  .50.  Before  treatment 
the  face  was  very  thin  and  contracted  at  the  ate  of  the  nose,  not 
unlike  Figs.  55,  56,  57.  She  is  a  mouth-breather.  There  is 
marked  thickening  of  the  mucous  membrane  and  hypertrophy 
of  the  turbinated  bones.  While  the  chest  is  very  much  con- 
tracted, it  is  now  filling  out.  She  has  a  husky  voice  and  a  very 
old  face.  This  case  shows  how  much  a  face  can  be  improved  by 
treatment. 


Fig.  47. 

Case  10,  Fig.  47.  Seven  years  of  age.  Father  and  mother 
living.  No  history  obtainable;  both  have  well-developed  jaws. 
This  boy  has  always  been  a  mouth-breather.  He  has  been  sick 
most  of  his  life.  He  has  so  little  vitality  that  it  was  with  diffi- 
culty he  has  been  raised  to  this  period  of  his  life  and  is  still  deli- 
cate. There  is  septum  deflection,  mucous  membrane  and  tur- 
binated bone  hypertrophy.  The  mouth  has  been  kept  open 
to  such  an  extent  that  occlusion  has  not  taken  place.  The  rami 
are  short;   the  result  of  this  is,  nature  has  caused  an  excessive 


166 


IRREGULARITIES    OF    THE    TEETH. 


development  of  the  anterior  alveolar  process.  Width  outside 
first  molar,  2;  outside  second  temporary  molar,  1.75;  width  of 
vault,  I  ;  height  of  vault,  36. 

Case  II,  Fig.  48.  Age  thirteen  years.  Father  and  mother 
living;  father  a  paranoiac.  He  has  an  excessively  developed 
forehead  and  well  developed  jaw.  The  boy  borders  on  imbecility. 
The  face  looks  like  tliat  of  a  man  thirty-five  or  forty  years  of 
age.  This  is  a  result  of  arrest  of  development  at  the  "senile" 
(four  and  one-half  month)  period  of  intra-uterine  Hfe.    The  whole 


Fig.  48. 

body  is  arrested  in  its  development.  His  legs  are  short  and  he 
walks  like  a  man  of  seventy.  His  joints  are  large,  while  the  bones 
are  very  small,  showing  impoverished  blood.  There  is  a  marked 
arrest  of  development  between  the  supercilary  ridges  and  the 
zygomai  and  also  the  lower  jaw.  This  gives  an  apparent  pro- 
trusion to  the  nose  and  upper  jaw.  The  eyes  and  their  sockets 
are  also  arrested.  He  is  obliged  to  wear  glasses  on  account  of 
astigmatism.  The  bones  of  the  nose  are  well  developed  and 
there  is  plenty  of  breathing  space.  He  has  a  growth  of  fine, 
white  hair  all  over  his  face.  The  ears  are  undeveloped.  The 
hearing  is  affected.    Width  outside  first  permanent  molar,  1.84; 


DKVELOPMKNTAL    NEUROSES    OF    THE    FACE. 


1()' 


outside  second  bicuspid,  1.75;    width  of  vault  between  second 
bicuspids,  .84;  height  of  vault,  .50. 

Case  12,  Fig.  49.  This  patient,  now  sixteen  years  of  age,  came 
to  have  a  deformity  of  the  mouth  corrected,  four  years  ago.  Her 
mother  is  a  neurotic.  Her  father,  although  a  large,  fleshy  man, 
has  small  jaws.  Marked  arrest  of  development  of  the  bones  of 
the  face  has  taken  place.  She  possesses  a  very  thin  nose,  deflec- 
tion to  the  left  of  the  septum;  enlarged  right  inferior  turbinated 
bones  and  hypertrophied  mucous  membrane.  She  is  a  mouth- 
breather  like  Fig.  48,  the  mouth  being  kept  open.    The  anterior 


Fig.  49. 

alveolar  process  has  developed  downward,  causing  the  teeth  to 
protrude.  Width  outside  of  first  molar,  1.95;  outside  second 
bicuspid,  1 .65  ;  width  of  vault,  i  ;  height  of  vault,  .47. 

Case  13,  Fig.  50.  There  is  here  excessive  development  of  the 
bones  of  the  face.  This  lady,  thirty-two  years  of  age,  married, 
has  one  child.  Father  and  mother  living  and  in  perfect  health. 
She  is  healthy  in  every  respect  and  above  the  average  in  intellect. 
Bones  of  the  face  are  normal,  except  zygomse,  which  are  exces- 
sively developed. 

Case  14,  Fig.  51.    This  patient  has  a  weak  physical  make-up; 


168 


IRREGULARITIES    OF    THE    TEETH. 


has  very  contracted  chest  and  stoops.  Marked  arrest  of  bones 
of  the  face,  long-  slender  nose,  the  outer  walls  coming  in  contact 
with  the  inner,  and  therefore  a  mouth-breather.  There  is  slightly 
excessive  development  of  the  lower  jaw.  He  was  supposed  to 
be  in  consumption  and  was  ordered  West.  The  change  of  cli- 
mate and  out-door  exercise  have  completely  restored  him  to 
health. 

Case  15,  Fig.  52.  This  gentleman  is  a  medical  student,  pos- 
sesses about  the  same  history  as  Case  14.  He,  however,  has 
more  marked  deformity.    There  is  a  great  arrest  of  development 


Fig.  .50. 

of  the  bones  of  the  face  and  a  more  marked  protrusion  of  the 
chin ;  this,  however,  does  not  show  owing  to  the  beard. 

On  comparison  of  these  cases  there  is  very  little  difference  in 
the  width  of  the  upper  jaw  in  the  first  five  cases.  Three  are  2, 
one  2.03  and  one  2.25.  Fig.  38  shows  arrest  of  development  at 
the  bridge  of  the  nose.  Fig.  39  shows  arrest  of  development 
of  the  bones  of  the  face  extending  from  the  supra-orbital  ridge, 
including  the  eyes,  zygonicC  and  superior  maxillae,  presenting 
a  concavity  of  the  face  as  far  down  as  the  superior  border  of  the 
inferior  teeth.     Fig.  40  is  precisely  like  Fig.  39  with  the  excep- 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE. 


169 


tion  that  the  zyg^omae  are  still  more  developed.  Fig.  41  is 
exactly  like  the  last  two,  with  the  exception  that  the  zygoinse 
are  still  further  developed.  In  V\g.  42  the  features  are  still  more 
normal,  but  arrest  of  development  is  not  noticed  at  the  alse  of 
the  nose.  Fig.  43  not  only  shows  arrest  of  development  of  the 
bones  of  the  face,  but  also  marked  arrest  of  the  inferior  maxilla. 
The  apparent  prognathism  is  the  same  in  all  except  Fig.  44. 
This  is  not  excessive  development  of  the  lower  jaw,  but  a  normal 
development.  The  lower  jaw  develops  independently  of  the  bones 


Fig.  5L 

of  the  head.  and.  owing  to  its  mobility, usually  develops  normally. 
The  apparent  prognathism  is  due  to  arrest  of  the  upper  jaw. 

In  a  large  number  of  cases,  however,  the  face  is  normal,  but 
the  undeveloped  lower  jaw  is  present.  Again,  the  bones  of  the 
face  are  normally  developed  upon  one  side  and  arrested  upon 
the  other.  In  these  cases  all  the  conditions  presented  in  the 
chapter  on  the  development  of  the  bones  of  the  face  are  readily 
seen. 

Comparing  these  faces  and  their  deformities  with  those  of 
the  degenerate  classes  the  deformities  of  one  do  not  differ  from 
the  other.    The  make-up  of  the  contour  of  the  head,  face,  jaws 


170 


IRREGULARITIES    OF    THE    TEETH. 


and  ears  of  degenerates  differ  from  the  others  only  under  dental 
observation. 

The  question  naturally  arises,  at  this  point,  as  to  how  fre- 
quently stigmata  occur  with  people  in  the  ordinary  walks  of  life. 
Repeated  examinations  in  street  and  steam  cars,  medical  and 
dental  colleges,  halls  and  practice  in  and  about  Chicago  have 
given  the  following  results :  In  practice,  68  per  cent ;  in  halls, 
cars,  etc.,  from  45  to  65  per  cent;  in  a  billiard  hall,  out  of  128 
persons,  either  playing  or  looking  on,  72  to  87  per  cent  of 
deformities  of  the  face  and  jaws.    In  medical  and  dental  colleges. 


Fig.  52. 


where  students  come  from  the  country  and  different  parts  of 
the  United  States,  the  percentage  will  fall  as  low  as  45  per  cent, 
while  the  congregation  of  city  people,  who  necessarily  include 
large  numbers  of  degenerates  from  rural  regions,  the  per  cent 
of  deformities  will  range  from  55  to  65.  It  would  not  be  fair  to 
take  the  percentage  of  my  patients  into  consideration,  because 
my  practice  is  made  up  largely  of  the  treatment  of  irregularities 
of  the  teeth.  In  analyzing  the  large  percentage  found  in  dental 
examinations,  the  fact  should'  be  remembered  that  irregularities 
of  the  jaws  and  teeth  come  under  observation  in  large  numbers 


DEVELOPMENTAL    NEUROSES    OF    THE    FACE.  171 

for  special  treatment.  It  would,  however,  be  safe  to  say  that 
from  55  to  60  per  cent  possessed  these  deformities.  Taking  the 
defective  classes,  which  include  numbers  of  acquired  cases  not 
necessarily  of  defective  birth  or  heredity,  as  a  whole,  as  found 
in  asylums,  the  difference  in  percentage  of  deformities  between 
them  and  society  at  large  is  not  striking.  If,  however,  congenital 
cases,  habitual  criminals,  drunkards,  prostitutes,  paupers,  etc., 
be  considered  the  percentage  is  from  85  to  95  per  cent. 

In  cases  just  cited  are  to  be  noticed  arrested  development  of 
the  orbit.  As  in  other  parts  of  the  face,  the  checking  of  the 
development  of  dermal  bones  plays  a  part  here.  The  poten- 
tialities of  the  infant  are  not  on  this  account  fulfilled.  As  I  have 
elsewhere  shown  when  the  typical  infant  begins  to  develop,  the 
cerebral  part  of  the  skull  predominates  over  the  facial  more  than 
in  the  adult,  the  superciliary  ridges  are  not  developed,  the  alveo- 
lar borders  are  not  prominent,  nor  are  the  cheek-bones,  the  nose 
is  without  a  bridge  and  the  cartilages  are  flat  and  generally  short, 
the  eyes  are  larger.  In  this  last  particular  the  human  infant 
resembles  the  lemurs  and  therein  retains  an  embryonic  tendency. 
In  some  degenerates  this  tendency  remains  unchecked.  The 
result  is  unusually  large  orbits.  In  other  instances  the  orbit  of 
the  human  foetus  passes  through  this  lemurian  stage  to  reach 
and  at  times  even  to  exceed  the  anthropoid  type  in  smallness 
and  close  approximation. 


CHAPTER  XVIII. 


DEVELOPMENTAL  NEUROSES  OF  THE  NOSE  AND 
INTERIOR  FACIAL  BONES. 

The  bones  of  the  nose  follow  the  same  laws  in  embryonic 
development  and  its  arrest  as  do  the  other  structures  of  the  head 
and  face.  As,  however,  completion  of  the  ossification  occurs 
very  nearly  at  that  great  period  of  stress,  puberty,  greater  varia- 
tions occur  at  that  period  even,  in  seemingly  otherwise  normal 
individuals  than  with  other  bones  of  the  head  and  face.  This 
stress  underlies  the  so-called  "catarrh"  of  puberty. 

Deformities  of  the  nasal  septum,  deflection,  hypertrophy  and 
atrophy  of  the  turbinated  bones  and  deformities  of  the  maxillary 
simuses,  are  generally  associated  with  arrest  and  excessive  devel- 
opment of  the  facial  and  maxillary  bones.  As  it  is  possible  to 
occasionally  find  deformities  of  the  maxillary  bones  without 
deformities  of  the  nose,  so  it  is  possible  to  find  deformities  of 
the  nose  without  maxillary  deformities. 

Theile  examined  117  skulls  and  found  the  septum  normally 
placed  in  29.  Semeleder  examined  49  and  found  the  deflection 
to  the  left  in  20,  to  the  right  in  15  and  sigmoid  deformity  in  4. 
Harrison  Allen,  in  58  skulls,  found  narrowing  to  the  left  side 
in  19,  to  the  right  in  21  ;  in  six  of  the  latter  the  septum  and 
superior  and  middle  turbinated  bones  met. 

According  to  Zuckerkandl  dry  skulls  do  not  give  an  accurate 
illustration  of  the  true  condition.  His  researches  were  made  upon 
the  cadaver;  out  of  370  cases  he  found  123  symmetrical  and  140 
asymmetrical ;  in  the  deformed  specimens,  the  septum  was 
inclined  to  the  right  in  57  cases,  to  the  left  in  51  and  was  sigmoid 
in  32.  Mackenzie,  on  examination  of  2,152  skulls  in  the  Museum 
of  the  Royal  College  of  Surgeons,  found  1,657  cases  where  the 
septum  was  more  or  less  deformed.  In  834  the  deviation  was 
to  the  left  and  in  609  to  the  right.  In  205  the  deflection  was 
sigmoid,  while  in  5  the  irregularity  was  zigzag,  showing  70  per 
cent  of  deformities  in  the  dry  skulls  and  only  40  in  the  cadaver. 

172 


ADOLESCENT    NEUROSES    OF    NASAL    AND    KACIAL    BONES.       173 

Heyman's  examination  showed  99  per  cent  of  deformities  in 
living  subjects.  With  the  status  already,  there  seems  to  be  quite 
a  difference  in  the  percentages  as  regards  races.  Thus  Zucker- 
kandl  found  in  103  cases  of  barbarous  and  semi-barbarous  people 
twenty-four  were  asynmietrical.  Mackenzie  found  in  430  skulls 
of  superior  races  22.0  per  cent  of  deformities  and  also  confirms 
the  observation  of  Zuckerkandl. 

Harrison  Allen  found  in  93  skulls  of  negroes  deformity  of 
the  septum  in  21.5  per  cent.  I  have  examined  over  11,000  in 
this  country  and  Europe,  including  the  large  collection  in  the 
Museum  of  the  Royal  College  of  Surgeons,  and  347  living  indi- 
viduals with  the  following  results :  Owing  to  the  fragility  of  the 
septum  the  whole  or  anterior  part  was  lost  in  many  of  the  skulls, 
the  results  of  which  only  7,600  had  sufficient  bone  remaining  to 
give  any  idea  of  its  shape.  My  examination  of  skulls  in  the 
Royal  College  of  Surgeons,  London,  practically  tallies  with 
Mackenzie.  In  the  7,600  skulls,  5,762  showed  marked  deform- 
ities. Out  of  687  ancient  Peruvian  skulls,  147  possessed  deflec- 
tion of  the  septum.  In  69  stone-grave  Indians,  35  were  normal 
and  34  deformed.  In  18  mound-builders,  8  were  normal,  10 
deformed ;  6  California  Indians,  4  were  normal. 

In  a  collection  by  J.  M.  Whitney,  of  Honolulu,  of  28  skulls 
of  ancient  Hawaiians,  taken  from  lava  caves,  the  jaws  were 
unusually  well  developed  as  well  as  the  bones  of  the  face.  The 
external  bones  of  the  nose  were  also  well  formed.  While  there 
was  a  lack  of  that  marked  asymmetry  due  to  excessive  arrest  of 
development  of  the  turbinated  bones,  as  noticed  in  Peruvian 
skulls,  yet  the  bones  were  far  from  being  uniformly  located  in 
the  cavities  of  the  nose.  There  were,  however,  two  in  which  the 
inferior  turbinated  bones  were  undeveloped,  only  rudimentary 
ridges  being  present.  Deflection  of  the  septum  was  noticed 
in  23  cases — some  in  the  anterior  part  of  the  bone,  others  in  the 
middle,  and  still  others  in  the  posterior  part.  In  the  two  cases 
where  the  inferior  turbinated  bone  was  undeveloped  the  septum 
deflected  to  that  side.  There  were  projections  which  seemed 
to  take  the  place  of  the  missing  turbinated  bones.  One  case 
was  observed  in  which  the  deflection  commenced  midway,  from 
before  backwards,  the  greatest  deformity  being  three-fourths  of 


174  IRREGULARITIES    OF    THE    TEETH. 

its  distance  into  the  left  cavity,  midway  between  the  turbinated 
bones.  Upon  that  side  of  the  vomer  there  was  a  large  ridge,  its 
greatest  projection  being  about  .25  of  an  inch  in  length.  Upon 
the  opposite  side  there  was  another  smaller  ridge,  evidently  for 
the  purpose  of  supporting  the  deflected  point,  and  also  for  the 
purpose  of  affording  greater  surface  for  mucous  membrane  and 
blood  supply.  Of  the  347  living  persons,  107  showed  deflection 
of  the  septum. 

Unlike  Zuckerkandl,  I  do  not  find  that  dryness  of  the  skull 
makes  any  difference ;  whether  it  be  from  a  living  subject,  on  the 
dissecting  table,  or  skull  that  has  been  grinning  from  the  shelf 
of  a  museum  for  twenty  years.  The  two  points  of  attachment 
are  fixed  (if  the  patient  has  reached  puberty),  and  the  septum, 
green  or  dry,  cannot  very  well  change  its  position,  except  there 
may  not  be  quite  so  noticeable  a  deflection  in  the  dry  subject. 

If  the  deformity  were  of  a  sigmoid  (S-shaped)  nature  upon 
one  side,  the  part  of  the  bone  or  cartilage  being  dry  would  pre- 
vent its  changing  to  the  opposite  side  in  the  one  case,  or  a 
reversal  of  the  S-shape  in  the  other.  Diagnosis  of  deflection  of 
the  septum  is  more  difficult  in  the  living  subject  or  cadaver  than 
in  the  dry  skull,  because  of  the  soft  tissues  located  in  the  anterior 
part  of  the  nose.  This  accounts  for  the  small  percentage  of 
deformities  reported  by  Zuckerkandl  and  myself.  I  found  great 
difficulty  in  making  my  examinations  upon  living  individuals; 
indeed,  it  seems  almost  impossible  to  discover  the  contour  of  the 
vomer  in  its  middle  and  posterior  parts,  where  they  are  as  fre- 
quently observed  as  in  the  anterior  part.  This  deformity  was 
of  all  manner  of  shapes,  sometimes  like  the  letter  S,  again  the 
letter  C,  and  often  like  the  small  italic  letter  f.  Sometimes  it 
would  be  carried  over  so  far  as  to  approximate  the  right  or  left 
wall  of  the  nose.  From  the  fact  that  it  is  attached  throughout 
at  its  upper  and  lower  border  to  a  solid,  bony  framework,  its 
middle  portion  is  liable  to  bend  in  any  direction  like  a  loose 
sail  in  the  wind.  Deflection  of  the  vomer,  due  to  fracture  of  the 
cartilage,  or  the  deflection  of  the  anterior  part  of  the  nose,  is 
easily  differentiated  from  a  fractured  vomer. 

Several  theories  have  been  advanced  as  to  the  cause  of  these 
deformities.     Quelmalz  and  Schultz  believed  they  were  due  to 


ADOLESCENT    NEUROSES    OF    NASAL    AND     FACIAL    HONES.       175 

the  action  of  astringents  drying  up  the  mcnil^rane,  causing  it 
to  contract,  thus  drawing  the  bone  and  cartilage  down  upon 
itself.  Morgagni  bcheved  they  were  due  to  excessive  develop- 
ment of  the  vomer.  Trendelenburg  held  they  were  due  to  a 
crowding  up  of  a  high-arched  palate,  as  he  had  observed  the 
two  conditions  frequently  connected.  Jarvis  has  reported  four 
cases,  all  in  the  same  family,  and  suggests  they  are  due  to  direct 
hereditary  defect,  while  neurotic  or  degenerate  conditions  which 
underlie  the  building  up  of  the  system  may  produce  the  deflec- 
tion, direct  hereditary  here  as  elsewhere  is  rare.  Schaus'  and 
Welcker's  investigations  show  there  is  a  faulty  development  of 
the  facial  skeleton.  Bosworth^  and  others  believe  that  septal 
deformities  are  due  to  traumatism.  According  to  Bosworth, 
"The  clinical  history  of  many  of  these  cases  affords  direct  evi- 
dence of  this,  and  even  in  those  cases  in  which  the  direct  injury 
is  not  testified  to,  I  think  it  safe  to  say  that  an  injury  has 
occurred,  which  may  have  been  of  so  slight  a  character  as  not 
to  have  excited  especial  attention  at  the  time  of  the  occurrence. 
An  injury  to  the  nose  need  not  necessarily  give  rise  to  the  imme- 
diate development  of  a  notable  deformity,  as  in  fractures,  but  it 
may  set  up  a  low  grade  of  morbid  action,  which,  going  on 
through  a  number  of  years,  will  finally  develop  a  condition  by 
which  the  normal  function  of  the  nose  is  seriously  hampered. 
The  point  on  which  I  would  lay  especial  emphasis  is  that  the 
deformity  is  primarily  the  result  of  traumatism  and  secondarily 
of  a  slow  inflammatory  process  which  results  therefrom."  That 
deformity  and  fracture  of  the  septum  may,  however,  be  traced 
to  traumatism,  I  am  personally  well  aware.  In  one  case,  when 
a  boy  of  sixteen.  I  asserted  my  rights  and  received  a  blow  upon 
the  nose  from  my  opponent  which  fractured  the  cartilage  which 
made  a  lasting  impression  upon  me.  The  theory  from  50  to  80 
per  cent,  or  even  5  per  cent  of  deformities  of  the  septum  are  due 
to  such  injuries,  is  demonstrably  illogical.  In  the  large  number 
I  examined,  2,684  possessed  what  appeared  to  be  fracture.  The 
vomer  in  many  of  these  specimens  commenced  to  deflect  at  its 
outer  surface  and  gradually  deepened  until  at  about  its  middle 
or  posterior  two-thirds,  it  reached  its  deepest  part  and  then  grad- 
^  Diseases  of  the  Nose  and  Throat. 


176  IRREGULARITIES    OF    THE    TEETH. 

ually  decreased  in  depth  until  the  posterior  attachment  was 
reached.  Its  appearance  was  not  unUke  the  sail  of  a  ship.  On 
the  convex  surface,  in  many  cases,  nature  had  thrown  out  pro- 
visional bone  to  support  this  curvature,  which  might  be  con- 
sidered a  break,  but  in  most  cases  simply  a  bend.  That  a  blow, 
whether  slight  or  as  powerful,  could  produce  a  fracture  of  the 
vomer,  the  greatest  deformity  of  which  is  located  from  .75  to 
two  inches  inside  the  nose  from  the  point  of  the  nasal  spine 
seems  hardly  probable.  Anterior  and  posterior  to  this  deflec- 
tion, the  vomer  appeared  in  most  cases  to  be  nearly  or  quite 
normal.  In  nearly  every  case  of  fracture  would  involve  only 
one-half  of  the  vomer,  the  other  simply  bending ;  that  such  a 
condition  could  be  brought  about  by  a  blow  is  absurd.  It 
seemed  the  greatest  deformity  was  the  thinnest  part  of  the  bone. 

It  would  appear  to  be  a  very  easy  matter  in  the  skull  to 
decide  whether  a  fracture  had  taken  place  before  or  after  com- 
plete ossification  by  the  character  of  the  wound,  thus  approx- 
imating the  date  of  the  injury.  That  it  was  caused  by  a  low  form 
of  inflammation  set  up  as  a  result  of  a  slight  injury  in  utero  or 
after  birth  does  not  seem  rational  since  the  inflammatory  con- 
dition must  necessarily  extend  upon  both  sides  of  and  through 
the  septum  extending  its  entire  length.  If  due  to  an  inflamma- 
tory condition  the  bend  or  break  W'ould  be  found  at  any  part  of 
the  septum  and  the  position  and  shape  would  be  different  in 
every  case.  As  the  location  upon  the  septum,  from  above  down- 
ward, is  nearly  always  the  same,  and  as  the  shape  is  always 
from  before  backward,  inflammation  could  not  produce  it.  In 
order  to  produce  a  fracture,  there  must  be  excess  of  septum. 
Therefore,  unless  the  fracture  is  the  result  of  a  direct  blow  it 
would  require  years  for  sufficient  growth  and  curvature  to  pro- 
duce a  condition  in  which  fractures  or  even  an  abrupt  bending 
could  take  place. 

The  theory  the  deformity  is  "primarily"  the  result  of  trau- 
matism due  to  injury  in  utero  or  at  the  time  of  delivery  or  even 
subsequently,  except  by  direct  force  and  secondarily  to  a  slow 
inflammatory  process,  will,  therefore,  not  account  for  these 
deformities.     Indeed,  fracture  of  soft  tissue,  such  as  the  vomer 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       177 

before   ossification,   is  not  possible.     The  theory  advanced  by 
Trendelenburg  cannot  be  maintained. 

Wherever  a  high,  contracted  vault  exists,  a  deflected  septum 
is  found.  Often,  however,  a  deflected  septum  is  found  without 
a  high  contracted  vault.  While  the  high  vault  and  deflected 
septum  go  hand  in  hand,  the  one  does  not  produce  the  other. 
It  has  been  shown  in  the  chapter  upon  the  development  of  the 
vault,  that  it  is  developed  downward  and  not  up.  The  develop- 
ment of  the  suture,  which  unites  at  the  median  line,  is  precisely 
like  laying  the  keel  of  a  ship,  only  upside  down;  it  is  laid  first 
and  is  the  foundation  upon  which  the  superstructure  rests.  The 
narrow,  contracted  vault  is,  except  in  monstrosities,  never  seen 
before  the  sixth  year.     Many  septa  are  deformed  before  that 


Fig.  33. 

date.  There  is  nothing  to  cause  upward  movement  of  the  vault. 
The  ridge  does  not  result  from  pushing  down  of  the  suture  by 
the  vomer.  The  vomer  must  be  taut  to  accomplish  this,  but 
it  is  always  bent  in  such  cases.  Again,  if  the  ridge  was  produced 
by  the  action  of  the  vomer  it  would  be  nearly  or  quite  uniform 
in  thickness  its  entire  length,  but  this  is  never  the  case.  If  it 
were  possible  to  crowd  down  the  middle  and  posterior  palate, 
it  would  be  impossible  to  crowd  down  the  anterior  part  of  the 
palate,  which  is  covered  by  the  anterior  alveolar  process.  I  have 
frequently  observed  a  ridge  extending  along  and  including  the 
alveolar  process  as  far  as  the  incisor  teeth.  In  1,367  skulls, 
containing  vaults  so  depressed,  I  have  never  found  a  correspond- 
ing depression  in  the  floor  of  the  nose. 

13 


178 


IRREGULARITIES    OF    THE    TEETH. 


It  would  be  as  impossible  to  force  down  the  vault  at  the 
median  line  as  it  would  be  to  force  a  keystone  through  a  brick 
or  stone  wall  by  the  weight  resting  upon  it.  The  author,  and 
others,  have  shown  that  deformed  septa  are  common  among 
early  and  pure  races,  who  do  not  possess  contracted  arches ;  so 
that  it  will  be  seen  that  one  is  not  dependent  upon  the  other. 
As  regards  length  of  septum,  I  agree  with  Morgagni,  that  it 
has  developed  beyond  normal,  and  in  order  to  accommodate 
itself  to  its  surroundings,  it  must  deflect  either  to  the  right  or 
left. 

In  some  cases  the  right  side  has  the  preference,  in  others 


Fig.  54. 


the  left  side  is  more  favored,  while  again,  there  is  an  even  divi- 
sion as  regards  deformities. 

The  first  seven  cases  which  I  shall  choose  for  illustration 
of  this  point  are  Peruvian  skulls  from  Harvard  college. 
The  cases  seen  in  Figs.  53  to  56,  inclusive,  are  well  devel- 
oped, while  those  in  Figs.  57,  58  and  59  are  arrested  in  their 
development.  These  photos  were  arranged  so  as  to  get  as 
much  light  into  the  cavities  as  possible.  Some,  however,  are 
quite  unsatisfactory,  for,  while  they  show  the  septum,  the  tur- 
binated bones  and  surrounding  parts  are  not  well  illustrated. 
Fig-  53  shows  the.  septum  deflected  to  the  left — resting  upon 
the  inferior  turbinated  bone  of  that  side.  The  right  turbinated 
hones  (which  are  poorly  shown)  are  excessively  developed,  to 
huch  an  extent  that  while  they  do  not  quite  touch,  they  take  the 
contour  of  the  nasal  septum.    Fig.  54  shows  a  similar  condition, 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES. 


179 


while  the  nasal  septum  is  not  deflected  quite  as  far.  The  right 
superior  turbinated  bone  is  excessively  developed,  but  not  to 
the  extent  of  the  inferior  one.  Fig.  55  shows  a  septum  almost 
straight.  The  left  inferior  turbinated  bone  is  well  shown.  The 
other  turbinated  bones  are  also  excessively  developed,  but  do 
not  extend  so  far  forward.  The  septum  is  divided  into  two 
parts.  It  will  be  observed  that  in  the  other  two,  unlike  this  one, 
the  turbinated  bones  are  arrested  in  their  development  upon 
one  side,  and  excessively  developed  upon  the  other.  Both 
cavities  are  entirely,  but  vmiformly,  filled  with  complete 
masses  of  soft,  spongy  portions  of  the  turbinated  bones.  Stig- 
mata are  marked  in  the  skulls,  while  the  cavities  of  the  nose  are 
smaller,  or  arrested  in  their  development.    The  two  sides  of  the 


Fig.  55. 


face  are  quite  unlike,  and  the  orbits  are  very  much  undeveloped. 
There  is  a  marked  arrest  of  development  of  the  left  maxillary 
Done,  which  contains  an  antrum  only  about  one-half  the  size  of 
the  right  side.  The  arrest  of  development  has  caused  the  teeth 
to  be  forced  out  on  a  large  circle,  in  order  that  they  may  come 
in  contact  with  the  lower  teeth.  This  action  has  caused  the 
roots  of  the  teeth,  in  many  cases,  to  protrude  through  the  outer 
plate  of  alveolar  process.  The  mastoid  processes  are  also 
excessively  developed.  A  profile  view  was  taken  of  this  skull 
(Fig.  56),  in  order  to  obtain  as  good  a  view  as  possible  of  the 
large  right  inferior  turbinated  bone.  This  bone  is  so  large  that 
it  extends  nearly  to  the  floor  of  the  cavity.  The  most  remark- 
able point  in  regard  to  this  deformity,  outside  of  the  excessively 


180  IRREGULARITIES    OF    THE    TEETH. 

developed  turbinated  bones,  is,  that  not  only  is  the  septum 
deflected  to  the  left  until  it  rests  upon  the  wall  of  the  cavity,  but 
that  the  nasal  spine  is  also  deflected.  In  Fig.  57  are  seen  nasal 
cavities  arrested  in  their  development.  The  septum  is  but 
slightly  curved  to  the  left.  The  nasal  cavities  are  filled  with 
excessively  developed  turbinated  bones,  and  the  spaces  between 
the  turbinated  bones  and  the  vomer  are  about  evenly  divided. 
In  Fig.  58  is  seen  a  very  small  nose,  the  vomer  is  deflected  to  the 
left  below,  and  at  about  one-third  of  the  way  up  it  takes  a 
decided  turn  to  the  right.  In  the  examination  of  the  turbinated 
bones  the  right  inferior  bone  is  very  large,  the  left  very  small, 
while  the  reverse  is  the  case  in  the  two  upper  bones.  In  Fig.  59 
are  seen  stigmata  of  degeneracy  in  the  nasal  cavities.    Here  the 


Fig.  56. 

vomer  is  about  straight,  while  the  turbinated  bones  upon  both 
sides  are  so  large  that  they  fill  the  cavities ;  the  spaces  between, 
however,  are  uniform  upon  both  sides.  Deflection  of  the  septum 
and  excessive  development  of  the  turbinated  bones  are  hence 
associated  with  large,  well-formed  nasal  cavities,  as  well  as  with 
small,  contracted  cavities  in  ancient  as  well  as  modern  people. 
The  same  relation  exists  between  the  vomer  and  turbinated 
bones  in  all  the  skulls  as  well  as  in  living  persons.  The  extent 
and  location  of  the  deformity  depend  upon  the  extent  of  develop- 
ment and  location  of  the  turbinated  bones.  They  may  not 
necessarily  be  excessively  developed  or  arrested  in  their  develop- 
ment, but  if  the  outer  walls  be  small,  reducing  the  size  of  the 
nasal  passages,   and  the  turbinated  bone  unevenly  situated  or 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       181 

nearly  filling  the  cavity,  the  septum  will  deflect  to  the  right  or 
left  and  conform  to  their  shape,  leaving  uniform  spaces  through- 
out the  entire  length  of  the  bone.  Inhalation  and  exhalation 
cause  the  vomer  before  or  during  ossification  to  deflect  to  the 
right  or  left,  according  to  the  size  and  location  of  the  turbinated 
bones.  The  air  striking  the  septum,  just  as  the  wind  strikes 
the  sail  of  a  boat,  produces  uniform  spaces  between  the  septum 
and  turJMnatcd  bones.  The  bend  or  breakage  is  almost  invari- 
ably at  a  point  of  the  concavity  just  midway  between  the  two 
turbinated  bones  on  that  side,  and  at  the  thinnest  part  of  the 
vomer.  When  the  turbinated  bones  are  undeveloped  upon 
one  side  and  excessively  developed  upon  the  other,  the  force 
of  air  causes  the  vomer  to  bend  toward  the  smaller  turbinated 


Fig.  57. 


bone,  thus  lengthening  it,  so  that  the  air  will  enter  and  leave 
uniformly  upon  both  sides,  as  illustrated  in  Figs.  53  and  54.  If 
the  turbinated  bone  is  large  upon  one  side,  the  force  of  air  will 
cause  the  unossified  vomer  to  develop,  and  if  the  cavity  of  the 
nose  is  large,  the  whole  volume  of  air  will  eventually  strike 
the  vomer  upon  one  side,  causing  it  to  bend  right  or  left  until  the 
air  is  uniformly  distributed  or  it  comes  in  contact  with  the 
turbinated  bones  upon  the  opposite  side.  In  Figs.  57  and  59, 
the  turbinated  bones,  developing  nearly  uniformly  upon  both 
sides  and  filling  the  nasal  cavity,  give  no  opportunity  for  the 
septum  to  deflect  to  the  right  or  left.  The  spaces,  therefore, 
are  uniform  upon  both  sides.  It  is  also  safe  to  say  that  when 
these  bones  are  covered  with  mucous  membrane  that  the  nose 


182  IRREGULARITIES    OF    THE    TEETH. 

was    completely   filled,    and     that    these    persons    were    mouth- 
breathers. 

Associated  with  unstable  development  of  the  superior  maxilla 
and  bones  of  the  nose,  must  necessarily  occur  unstable  develop- 
ment of  the  mucous  membrane,  resulting  in  a  thickening  of  the 
membrane  and  adenoid  grow^ths.  These  conditions  are  almost 
always  to  be  found  in  connection  with  stigmata  of  degeneracy. 
Idiots,  imbeciles,  etc.,  patients  possessing  (apparently)  high 
vaults,  are  hence  mouth-breathers.  There  is  an  arrest  of  devel- 
opment of  the  bones  of  the  face,  jaw  and  nose.  The  patient 
cannot  breathe  through  the  nose ;  the  mouth  being  open  the 
teeth  and  alveolar  process  develop  down  for  want  of  antagonism ; 


Fig.  58. 

and  the  contracted  vault,  which  looks  high  l)ecause  of  the  arrest 
of  development,  results. 

It  is  quite  common  to  find  entire  arrest  of  the  inferior  tur- 
binated bones  upon  one  side  or  upon  both  sides.  Again,  one 
or  both  inferior  turbinated  bones  will  be  partially  developed. 

The  following  skulls,  in  the  Army  Medical  Museum  at  Wash- 
ington, possess  such  deformities : 
Alaska  Indians — 

Skull  No.   1,090,  case  177;  low^er  right  turbinated  bone 

undeveloped. 
Skull  No.  1,092,  left  inferior  turbinated  bone  undeveloped, 

vomer  gone. 
Skull    No.    T.094   both    inferior   turbinated    bones   unde- 
veloped. 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    liONES.       183 

Skull  No.  2,431,  no  inferior  turbinated  bone. 

Skull  No.  2,453,  "O  inferior  turbinated  bone. 

Skull  No.  2,798,  no  inferior  turbinated  bone. 

Skull  No.  2,451,  no  left  inferior  turbinated  bone. 

Skull  No.   1,216,  case  i8o;  both  inferior  turbinated  bones 

undeveloped. 
Many  Peruvian  skulls  show  undeveloped  inferior  turbinated 
bones.    Thus : 

Skull   No.  630,  case   166;  no  ri^ht  inferior. 

Skull  No.  631,  case   166;  no  right  or  left  inferior. 

Skull  No.  115,  case  167;  no  left  inferior  turbinated  bone. 

Individual    over   twenty-two   years   of   age   at   time   of 

death. 


Fig.  59. 

Excessive  development  of  the  turbinated  bones  is  also  very 
common.  Thus,  No.  2. 131,  case  175,  \"ancouver  Island  Indians: 
The  right  middle  turbinated  bone  is  excessively  developed,  so 
that  it  falls  the  anterior  middle  of  the  nasal  cavity  with  a  large 
cavity  in  the  center.  The  left  mi  Idle  and  right  and  left  inferior 
bones  were  well  developed,  filling  both  nasal  cavities.  In  this 
case  the  vomer,  which  stands  uniformly  between  the  turbinated 
bones,  takes  the  shape  of  the  letter  S.  No.  2,129,  Vancouver 
Island  Indiaiis,  shows  left  superior  turbinated  bones ;  exces- 
sively developed  to  a  level  with  middle  turbinated  bone.  The 
vomer  is  deflected  to  the  right,  then  to  the  left,  in  order  that 
it  may  stand  in  a  central  position.  Skull  1,309.  case  173,  illus- 
trates the  theory  of  the  author  very  nicely.  The  right  middle 
turbinated  bone  undeveloped,  inferior  right  excessively  devel- 


184 


IRKEGULARIIIES    OF    THE    TEETH. 


oped ;  the  vomer  at  its  middle  takes  a  V-shape,  in  order  that 
it  may  stand  in  the  middle  between  the  turbinated  bones. 

That  inhalation  and  exhalation  govern  the  development  and 
shape  of  the  bones  of  the  nose  is  shown  in  many  ways.  When 
the  nasal  cavities  are  small  and  the  bones  become  enlarged  upon 
one  side,  the  outer  wall  will  become  concave,  encroaching  upon 
the  antrum.  Again,  when  the  nasal  cavities  are  small,  the  tur- 
binated bones  will  develop  and  curl  upon  themselves  so  that 
uniform  space  is  obtained  for  the  passage  of  air.  In  a  long,  nar- 
row nasal  passage  the  bones  will  develop  long  and  narrow ;  the 
superior  turbinated  bone  will  develop  down,  sometimes  below 
the  lower  edge  of  the  superior  turbinated  bone.  In  other  cases 
the  nasal  cavities  will  be  short  and  broad.     In  these  cases  the 


Fig.  GO. 

bones  will  become  large  and  short.  They  may  develop  straight 
out  from  the  outer  wall,  and  then  turn  upon  themselves  back 
to  the  point  of  origin.  Sometimes  they  are  very  thin  and  dense, 
like  the  vomer.  Again,  they  are  thick  and  cancellated,  like  the 
spongy  alveolar  process.  Occasionally  one  nasal  cavity  will  be 
lower  than  the  other.  In  such  cases  a  corresponding  deformity 
is  almost  sure  to  result  in  the  vault.  When  the  nasal  cavities 
are  not  uniform  in  development — that  is,  narower  in  front  than 
behind — the  turbinated  bones  will  develop  posteriorly,  and  either 
become  undeveloped  anteriorly  or  will  curve  more,  so  that  air 
may  be  evenly  distributed  throughout  the  cavity.  When  the 
turbinated  bone  develops  larger  or  smaller  behind  than  in  front, 
the  bone  will  bend  upon  itself  to  conform  to  this  deformity. 


ADOLKSCKNT    NKUUOSKS    Ob'     NASAL    AND    FACIAL    IJONKS.       185 

Skull  No.  736.  case  179,  has  also  a  very  marked  deformity 
of  the  vomer;  it  is  bent  in  both  directions.  The  anterior  half 
is  midway  between  the  turbinated  bones,  while  the  posterior 
half  is  bent  to  the  right,  the  greatest  point  being  between  the 
right  upper  and  lower  turbinated  bones.  Both  concavities  have 
projections — one  to  the  right,  the  other  to  the  left.  The  anterior 
curvature  of  the  vomer  is  the  largest;  and  for  this  reason  the  left 
turl)inatcd  bone  is  undeveloped.  This,  however,  does  not  allow 
sufficient  room  for  the  air  to  become  evenly  distributed  through 
the  nostril  upon  one  side.  The  most  remarkable  thing  is  that 
to  procure  room  the  air  had  forced  the  vault  of  the  mouth  on 


Fig.  61. 

that  side  downward,  making  a  very  marked  and  noticeable 
deformity.    The  dental  arch  is  well  developed. 

Occasionally  the  turbinated  bones  are  so  situated  that  the 
air  will  deflect  the  vomer  to  one  side  or  the  other  in  such  a  man- 
ner that  there  will  be  a  deformity  at  right  angles,  just  below 
the  inferior  turbinated  bone.  This,  however,  cannot  be  located 
very  near  its  place  of  attachment,  for  the  reason  that  the  vomer 
commences  to  enlarge  or  thickens  as  it  reaches  the  nasal  spine, 
thus  preventing  the  bend. 

The  drawings  of  Zuckerkandl  are  here  given  because  they 
illustrate  the  points  made,  and  are  true  to  life. 

Figure  60  shows  the  bone  very  unevenly  developed.  This 
is  partly  due  to  an  excessively  developed  antrum  upon  the  left 


186 


IRREGULARITIES    OF    THE    TEETH. 


side  and  a  correspondingly  small  one  upon  the  right  side.  It 
will  be  noticed  that  the  turbinated  bones  and  vomer  are  so  dis- 
tributed that  there  is  a  uniformity  of  space  throughout  the  cavity. 
The  vomer  even  has  deflected  to  the  right  in  order  to  produce 
this  harmony.  It  will  be  observed,  however,  that  the  bone  is 
not  broken,  but  simply  bent,  and  that  this  bend  is  almost  oppo- 
site the  enlarged  left  inferior  turbinated  bone.  Although  the  face 
is  very  asymmetrical,  the  bones,  which  are  intended  for  the  pur- 
pose of  warming  the  air,  are  nicely  arranged.  The  right  cavity  is 
considerably  lower  than  the  left ;  the  inferior  turbinated  has 
lengthened  to  correspond.  Aspiration  has  separated  the  lateral 
halves  of  the  vomer,  and  the  space  has  filled  in  with  bone. 


Fig.  62. 

Figure  6i  presents  quite  another  state  of  things.  Here  the 
facial  bone  is  uniformly  developed ;  the  antra  are  comparatively 
uniform ;  the  turbinated  bones,  however,  are  very  unevenly 
developed.  The  bend  and  break  in  the  vomer  are  about  at  a 
point  betwen  the  two  turbinated  bones,  and  exactly  opposite 
the  excessively  developed  right  inferior  turbinated  bone.  It 
will  be  observed  that  the  bend  is  no  greater  in  the  one  than  in 
Fig.  60,  and  yet  in  Fig.  61  the  left  plate  is  fractured,  while  the 
right  one  is  slightly  bent.  This  is  usually  the  case.  There  is  not 
a  complete  fracture,  but  a  semi-fracture. 

Figure  62  shows  still  a  different  condition.  The  left  antrum 
is  nearly  closed;  to  compensate  for  this  a  number  of  sinuses  are 
formed.     In  order  that  the  air  may  be  warmed  uniformly  the 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       187 


septum  has  developed  to  the  left.  The  lower  part  has  enlarged, 
and  the  middle  has  deflected  to  the  right,  thus  giving  a  more 
uniformity  of  spaces.  The  right  inferior  turbinated  bone  has  also 
enlarged  for  the  same  purpose. 

Fig.  63  is  an  excellent  illustration  of  arrest  of  development 
of  the  bones  of  the  face,  nose  and  jaws.  The  bones  are  very 
unevenly  developed,  with  excessive  development  of  the  left 
superior  turbinated  bone,  which  has  a  cavity  in  it  no  doubt  for 
the  purpose  of  producing  more  surface  for  the  blood  supply. 
An  individual  wath  such  a  development  must  necessarily  possess 
a  degenerate  condition,  with  weak  lungs,  small  chest,  and  low 
vitality.     In  order  that  the  air  may  be  uniformly  w-armed  the 


Fi'S-  6.S. 

septum  has  deflected  toward  the  right.  The  vomer  has  deflected 
toward  the  right  in  order  that  the  turbinated  bone  may  have 
room,  and  also  to  furnish  uniform  space.  The  septum  in  this 
case  is  bent  and  not  broken. 

Fig.  64  is  another  form  of  deformity  which  I  have  occasion- 
ally observed.  In  this  case  the  nasal  cavities  extend  laterally 
nearly  outside  of  the  alveolar  process.  Were  one  to  undertake 
to  open  the  antrum  through  the  cavities  of  the  teeth  he  would 
drill  into  the  floor  of  the  nose.  I  have  observed  such  cases. 
Having  such  a  large  space  the  turbinated  bones  have  adjusted 
themselves  to  the  best  advantage.  The  septum  also  has  adapted 
itself  as  best  it  can  by  deflecting  toward  the  left  side,  having  bent 
itself  at  its  w^eakest  part  and  opposite  the  enlarged  turbinated 
bone.     There   is,  however,  a  large  space  upon  the  right  side 


188 


IRREGULARITIES    OF    THE    TEETH. 


between  the  two  turbinated  bones.  The  thickness  of  the  bone 
prevents  its  being  bent  by  the  pressure  of  air,  and  excessive 
development  of  the  vomer  has  taken  place  upon  that  side  as 
a  substitute. 

Fig.  65  shows  the  turbinated  bones  upon  both  sides  exces- 
sively and  uniformly  developed,  the  result  of  which  is  that  the 
vomer  is  straight  upon  the  left  side,  while  the  right  half  has  been 
torn  away,  and  by  aspiration  the  air  has  drawn  it  slightly  into 
the  space  between  the  two  bones. 

Figs.  66  and  67  are  drawings  taken  from  frozen  specimens 
in  the  Army  Medical  Museum  at  Washington,  showing  that 
the  parts  of  fracture  and  deflection  are  situated  between  the 
turbinated  bones. 


A  skull  in  my  possession  is  that  of  a  girl  fourteen  years  of 
age,  who  died  of  consumption.  There  is  hardly  a  bone  whicfi 
goes  to  make  up  the  skull,  including  the  lower  jaw,  that  does 
not  show  stigmata  of  degeneracy.  The  left  inferior  turbinated 
bone  did  not  develop.  A  simple  ridge  is  present  where  the  bone 
should  be  attached  to  the  outer  wall.  The  right  inferior  tur- 
binated bone  is  excessively  developed.  The  vomer  has  curved 
to  the  side  where  there  is  space  and  from  the  enlarged  right  tur- 
binated bone.  Although  there  is  quite  a  bend,  still,  owing  to  the 
fact  that  the  girl  died  at  the  age  of  fourteen,  this  is  not  as 
marked  as  it  would  have  been  had  she  lived. 

Another  case  is  that  of  a  bone  projecting  .36  of  an  inch, 
(situated  upon  the  right  side  of  the  vomer  just  midway  between 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    HONES.       189 


the  superior  and  inferior  turbinated  bones),  .75  of  an  inch  in 
length,  1.50  inch  in  from  the  nasal  spine,  and  .50  of  an  inch 
from  the  posterior  border,  which  is  comparatively  straight.  The 
anterior  part  is  slightly  curved,  but  perfectly  straight  .50  of  an 
inch  anterior  to  the  commencement  of  the  deformity.  There  is 
a  slight  groove  upon  the  opposite  side  of  the  vomer  to  cor- 
respond to  the  line  of  projection.  It  stands  just  midway  between 
the  two  turbinated  bones.  This  is  not  a  fracture,  nor  can  it  be 
claimed  that  the  projection  is  for  the  purpose  of  repairing  a 
fracture.  The  length  of  this  projection  would  alone  preclude 
such  an  idea.    These  projections  vary  from  a  mere  ridge  up  to  a 


Fig.  65. 

projection  .36  of  an  inch  in  w'idth.  It  would  seem  that  nature, 
being  unable  to  develop  the  bone  sufficiently  to  carry  it  far 
enough,  built  out  a  projection  in  order  to  complete  its  design. 

These  projections  were  first  mentioned  by  Langenbeck,  who 
gave  to  them  the  name  of  exostoses.  They  were  afterward 
described  by  Theile,  Harrison  Allen  and  John  Mackenzie. 
''These  projections,"  according  to  Bosworth,  "are  always  found 
along  the  sutural  lines  of  the  septum,  and  consists  in  a  more  or 
less  well-developed  angular  prominence  or  ridge,  which  pro- 
jecting into  the  nasal  passage,  acts  to  obstruct  normal  respira- 
tion." 

This  has  not  been  my  experience.  I  have  always  found  them 
situated  upon  the  convex  surface,  and  the  greatest  projection 


190 


IRREGULARITIES    OF    THE    TEETH. 


being  at  the  weakest  point  of  the  septum.  As  the  greatest 
deformity  may  be  located  at  any  point  between  the  anterior  and 
posterior  edges  of  the  bone,  the  greatest  point -of  projection 
may  occur  on  any  part  of  the  septum,  but  always  situated  mid- 
way between  the  turbinated  bones.  This  projection  is  due  to 
irritation,  from  inhalation  and  exlialation. 

In  deviation  of  the  vomer  to  the  right  or  left,  with  a  decided 
depression  always  at  a  point  where  there  is  the  greatest  space; 
sometimes  in  the  anterior  part  of  the  bone,  and  often  in  its  pos- 
terior part ;  sometimes  high  up,  and  again  low  down,  depending 
upon  the  location  of  the  turbinated  bone,  with  a  rib  of  bone 
developed  upon  its  convex  surface.     It  seems  to  be  a   super- 


numerary turbinated  bone.  The  deflection  and  the  supernumer- 
ary turbinated  bone  compensate  for  the  space  on  either  side  of 
the  nose.  Just  as  the  intelligence  of  the  individual  depends 
upon  the  amount  of  gray  matter  in  the  brain,  and  the  gray  matter 
depends  upon  the  number  of  lobes  or  convolutions,  so  the  warmth 
of  air  which  is  taken  into  the  lungs  depends  upon  the  amount  of 
blood,  the  blood  upon  the  amount  of  mucous  membrane,  and 
the  mucous  membrane  upon  the  contortion  of  the  bones  of  the 
nose  to  produce  surface.  If  they  are  arrested  upon  one  side, 
those  upon  the  other  enlarge  or  elongate,  and  thus  make  up  for 
the  deformity.  When  the  inferior  turbinated  bone  is  entirely 
arrested  the  bend  in  the  septum  and  projection  seems  to  compen- 
sate for  the  loss.  In  neurotics  and  degenerates,  in  many  cases,  the 
lungs  and  the  chest  walls  are  undeveloped  and  very  delicate. 


ADOLESCENT    NEUROSES    OF    NASAL    AND     FACIAL    HONES. 


191 


The  deforniities  take  place  before  puberty,  and  in  a  majority 
of  cases  before  the  sixth  year.  The  arrest  of  development  of 
the  jaw  takes  i)lace  at  the  time  the  second  teeth  erupt,  and  the 
arrest  of  the  nose  and  face  shows  that  the  individual  possesses 
a  face  of  that  age. 

The  width  of  the  external  nasal  cavity  varies  considerably. 
In  2,000  cases,  the  greatest  width  was  1.25  of  an  inch;  the 
smallest  width  w^as  .75.  The  length  from  the  nasal  spine  to  the 
edge  of  the  nasal  bones  was  (greatest  length)  1.54  and  the  small- 
est 1.20  of  an  inch.  These  skulls,  however,  are  made  up  of 
Peruvians,  stone-grave  Indians,  mound-builders,  clifT-dwellers, 
Hawaiians,  etc..  etc.     In  neurotics  and  degenerates,  when  arrest 


Fig.  67. 

of  development  of  the  face  and  nose  had  taken  place,  I  found 
that  the  wndth  measured  .50  to  .60  of  an  inch,  and  the  length 
.80  to  .90  of  an  inch.  In  these  cases,  if  the  turbinated  bone 
developed  uniformly,  the  vomer  will  be  straight.  If  asymmetry 
exist,  the  vomer  will  be  deflected  to  one  side  or  the  other,  in 
which  case  the  bone,  when  covered  with  mucous  membrane, 
wall  fill  the  cavity  of  the  nose  and  mouth-breathing  will  result. 

On  general  view  of  the  nose,  a  want  of  harmony  in  its  general 
outline  in  many  cases  is  seen.  The  nasal  bones  become  arrested 
in  their  development,  and  the  tip  of  the  nose  is  turned  up,  owing 
to  a  normal  or  excessively  developed  cartilage.  Another  and 
very  marked  deformity  is  one  in  which  the  nasal  bone  and  car- 
tilage are  excessively  developed.    The  bone  takes  one  angle  and 


192  IRRKGUI-ARITIES    OF    THK    TEpyiH, 

the  cartilage  another,  producing  a  donljle  nose.  This  condition 
is  very  common  among  Hebrews.  There  are,  however,  Ameri- 
cans who  have  nasal  organs  containing  material  enough  for  two 
fair-sized  noses.  In  a  majority  of  these  cases  there  is  a  total 
collapse  of  the  walls  of  the  nose,  and  frequently  mouth-breathing 
results. 

Fig.  70  illustrates  such  a  case,  although  the  nose  is  not 
nearly  as  large  as  these  two  I  have  just  described.  This  illus- 
tration, however,  gives  a  fair  idea  of  such  cases.  In  over  2,000 
measurements  of  the  nasal  bones,  the  shortest  was  found  to  be 
.40,  the  longest  1.65  of  an  inch  in  length.  It  will  be  seen  that 
even  the  bones  without  the  cartilage  would  make  a  fair-sized 
nose.  These  bones  take  different  angles.  It  would  seem  that 
those  which  are  the  largest  take  the  greatest  angle.  A  form  of 
deformity,  which  is  more  common  than  is  generally  supposed, 
is  that  in  which  the  nose  is  deflected  to  the  right  or  left.  This 
deformity,  however,  is  often  so  great  that  it  produces  a  marked 
asymmetry  of  the  face,  and  often  so  slight  as  to  be  unnoticed 
by  the  average  observer.  There  is  no  doubt  that  it  is  carried 
to  the  right  or  left  by  the  cartilaginous  septum,  when  only  the 
soft  tissues  are  involved ;  but  when  the  bones  of  the  nose  are 
deformed,  quite  another  condition  exists.  Marked  deflection, 
as  well  as  other  deformities  of  the  nose,  are  not  observed  in 
early  life,  but  as  the  face  develops  the  deformity  becomes  more 
prominent,  and  at  puberty  is  well  defined,  although  it  does  not 
reach  its  full  development  until  twenty-five  or  thirty  years.  In 
most  every  instance  the  two  lateral  halves  of  the  face  are  asym- 
metrical, as  well  as  the  nasal  bones.  The  bones  of  the  nose 
develop  upon  one  side  and  deflect  the  lower  border  to  the  oppo- 
site side,  where  the  bones  are  undeveloped.  This  has  a  tendency 
to  deflect  the  cartilaginous  septum  in  the  same  direction,  which, 
in  turn,  exaggerates  the  deformity.  Noses  in  neurotics  and 
degenerates  may  be  deflected  nearly  45°  from  a  normal  position. 
The  claim  has  been  made  that  these  marked  deflections  are  due 
to  injury  in  utero  or  at  birth.  As  the  bones  of  the  nose  are 
undeveloped  at  birth,  and  as  marked  deflection  is  not  observed 
until  later  in  life,  such  a  theory  does  not  fit  the  case. 

At  birth  the  nasal  cavities  are  not  evenly  developed.     If  one 


ADOLKSCENT    NKUROSKS    OF    NASAL    AND    FACIAL    IJONES.        11);] 

side  is  larger  than  the  other,  more  air  will  pass  through  one  side 
than  the  other.    If  the  two  sides  are  nearly  even,  the  amount  of, 
air  will  be  about  uniformly  distributed. 

Ziem  has  shown  that  if  one  nostril  of  a  rabbit  be  permanently 
closed  and  the  animal  killed  after  it  has  attained  its  full  growth, 
the  nasal  cavity  of  the  afifected  side. will  be  found  to  be  unde- 
veloped, and  asymmetry  of  the  face  will  have  taken  place.  This 
is  also  the  case  when  one  side  is  undeveloped;  the  air  passes 
through  the  opposite  side  and  the  passage  becomes  enlarged. 
A  greater  quantity  of  air  passing  through,  a  greater  surface  of 
mucous  membrane  is  required  to  warm  it.  The  turbinated  bones 
become  physiologically  enlarged,  owing  to  the  stimulation  of 
the  air,  and  the  vomer  is  carried  to  the  weak  side.  The  unde- 
veloped condition  of  the  nose  and  asymmetry  of  the  face  of 
animals,  as  demonstrated  by  Ziem,  can  be  accounted  for  in  no 
other  way  than  a  want  of  stimulation  of  air  inhaled  and  exhaled. 

The  septum  ossifies  much  slower  than  the  surrounding  bone, 
and  therefore  it  is  more  easily  moved  out  of  its  normal  position. 
At,  or  about  the  sixth  year,  the  deformity  is  well  established. 
The  air  stimulates  a  physiological  development  of  the  septum, 
and  it  bends  toward  the  undeveloped  side.  It  grows  faster  than 
the  points  of  attachment,  and  as  a  result  the  septum,  according 
to  the  law  of  mechanics,  bends  toward  the  smaller  part.  When 
inhalation  takes  place,  the  air  passing  through  the  undeveloped 
passage,  produces  suction,  thus  drawing  the  bone  toward  that 
side ;  while  upon  the  other  hand,  the  large  volume  of  air  passing 
through  the  large  nostril,  forces  it  in  the  same  direction.  Thus, 
by  aspiration  and  pressure,  the  thinner  part  of  the  bone  is  bent 
to  the  weaker  side,  which  gives  a  uniform  space  for  the  pressure 
of  air  throughout  the  nose.  The  location  of  the  deformity 
depends  upon  the  asymmetry  of  the  two  sides  and  the  thinness 
of  the  vomer.  Close  examination  of  section  of  the  vomer  shows 
projection  upon  one  side  or  the  other,  and  sometimes  vipon  both 
sides,  due  to  fracture  or  excessive  development  of  bones  that 
they  are  always  located  between — the  turbinated  bones.  They 
are  not  just  in  the  center,  but  not  far  from  it.  These  are  also 
the  result  from  stimulation  by  exhalation  or  aspiration  of  air, 
producing  healthy  physiologic  action  at  that  point. 

14 


194  IRREGULARITIES    OF    THE    TEETH. 

When  a  slight  irritation  of  the  mucous  membrane  takes 
place,  as  a  result  of  cold,  it  thickens.  The  child  experiences 
difficulty  in  breathing.  In  the  spasmodic  effort  to  draw  air  into 
the  lungs  through  the  nose  a  vacuum  is  formed  and  the  septum 
is  developed  and  drawn  to  the  point  of  least  resistance,  which 
would  naturally  be  at  a  point  between  the  turbinated  bones.  In 
this  manner  the  septum  takes  the  outline  midway  between  the 
bones.  The  fracture  very  rarely  extends  through  the  two  halves 
of  bone ;  only  one  side  breaking,  while  the  other  is  simply  bent. 
The  fractured  half  being  always  upon  the  convex  side  leads  to 
the  opinion  that  it  is  due  tofijthe  thickeningof  the  mucous  mem- 
brane, (2)  accumulation  of  moisture  or  purulent  mucus,  and  (3) 
an  excessive  effort  on  the  part  of  the  patient  to  draw  air  through 
the  nose.  This  being  impossible  the  vomer  is  drawn  into  the 
space  after  partial  ossification  has  taken  place,  and,  as  a  result, 
fracture  of  that  half  and  simple  bending  of  the  other  half.  The 
edges  of  the  broken  half  are  torn  apart  from  the  other  half,  pro- 
ducing a  space  between,  which  is  eventually  filled  up  with  bone 
cells.  This  condition  is  not  unlike  the  fracture  of  a  green  stick. 
Sometimes  it  will  be  drawn  to  the  right  side  in  one  place  and 
to  the  left  in  another.  Again,  in  the  same  manner,  the  two 
lateral  halves  are  separated  their  entire  length,  as  illustrated  in 
Fig.  55.  There  is  a  projection  of  the  right  half  at  a  point  midway 
between  the  right  turbinated  bones.  This  seems  to  be  only 
natural,  since,  in  many  cases,  the  deflection  and  fracture  only 
extends  a  short  distance  in  the  anterior  middle,  or  posterior 
part  of  the  vomer,  while  the  bone  will  be  perfectly  straight 
anterior  and  posterior  to  the  deformity.  The  shape  of  the  deflec- 
tion and  fracture  can  be  accounted  for  in  no  other  way.  In 
order  that  fracture  may  take  place,  the  vomer  must  have  ossified 
partially  or  completely,  which  occurs  at  middle  life;  therefore 
injuries  in  utero  or  subsequently,  before  ossification,  are  out  of 
the  question.  If  the  turbinated  bones  be  uniformly  developed 
the  vomer  will,  in  most  cases,  remain  quite  or  nearly  straight. 
The  force  produced  by  drawing  air  will  frequently  separate  the 
two  halves  and,  occasionally,  produce  one  fracture  upon  one  side, 
the  other  upon  the  other  side.  Not  only  are  the  cartilages  of  the 
nose  brought  in  close  relation  to  each  other,  but,  occasionally, 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       195 

the  force  is  so  great  that  there  is  a  total  collapse  of  the  outer 
bony  walls  and  they  are  drawn  toward  the  septum,  making  a 
groove  upon  either  side,  the  nasal  bones  remaining  perfectly  flat 
at  the  upper  edge. 

Deviation  of  the  nasal  septum  to  one  side  or  the  other  is  the 
result  of  an  unequal  development  of  adjacent  bony  parts,  more 
especially  and  directly  of  that  of  the  turbinated  bones.  It 
depends  largely,  if  not  exclusively,  u])<)n'the  development  and 
position  of  these  latter.  They,  in  turn,  are  dependent  in  great 
measure  upon  the  development  of  the  facial  bones,  which  are 


Fig.  68. 

modified  as  the  facial  angle  increases  and  prognathism  is  lost. 
The  turbinated  bones  being,  as  it  were,  exostosed,  not  molded 
in  many  directions  by  adjacent  parts,  encroaching  more  irregu- 
larly upon  the  nasal  cavity,  as  their  origins  are  disturbed  or  dis- 
located. Freedom  of  these  nasal  passages  for  transit  of  respired 
air  is  essential.  In  normal  respiration  the  tendency  is  for  both 
nostrils  to  share  equally.  The  natural  consequence  is,  that  the 
vomer,  the  ossification  of  which  is  incomplete  until  puberty,  is 
deflected  and  occupies,  as  a  rule,  nearly  a  midway  position 
between  the  bony  prominences  on  either  side.     Deflection  of 


196 


IRREGULARITIES    OF    THE    TEETH. 


the  septum  hence  is  compensatory  arrangement  for  the  evolu- 
tionary variations  of  facial  development.  It  is  therefore  most 
frequent  in  the  higher  races,  while  in  the  lower  its  occurrence 
is  markedly  less. 

Instability  of  tissue-building  is  to  be  expected  in  neurotics 
and  degenerates.  It  is  easy  to  see  how,  with  such  an  unstable 
bone  tissue  to  build  upon,  the  mucous  membrane  of  the  nose 
can  take  on  atrophy,  hypertrophy  and  adenoid  growths,  result- 
ing in  mouth-breathing. 

Total  collapse  of  the  outer  walls  of  the  nose  is  frequently 


FiR.  69. 

observed  among  neurotics  and  degenerates.  This  is  associated 
with  arrest  of  development  of  the  bones  of  the  face,  jaws,  deform- 
ities of  the  dental  arch,  weak,  contracted  chest,  round  shoulders, 
husky  voice,  etc.  In  most  cases  of  this  description  the  nose  is 
very  long  and  thin.  The  nasal  bones  are  excessively  developed 
or  arrested,  with  marked  deflection  of  the  septum.  Frequently 
nasal  catarrh  is  present.  When  the  patient  attempts  to  inhale 
air  the  outer  walls  are  brought  together  and  nose-breathing  is 
impossible.  The  result  is  mouth-breathing,  not  only  taking 
cold  air  into  the  lungs,  but  also  diseased  germs.  The  preceding 
illustrations   (Figs.  68,  69  and  70)  are  those  of  persons  who 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       197 

possess  all  of  the  signs  herein  enumerated.  These  pictures 
are  front  views  of  those  used  in  the  chapter  upon  deformities 
of  the  face,  and  are  intended  to  illustrate  the  long,  slender  nose. 
By  comparing  these  with  those  representing  the  side  view,  a 
very  good  idea  of  the  thinness  may  be  obtained.  Three  of  these 
persons  are  now  infected  with  tuberculous  deposits,  and  the 
fourth  will  require  the  best  of  care  to  prevent  infection.  It  is 
possible  for  persons  to  contract  tuberculosis  who  do  not  present 
stigmata,  but  parents  who  have  children  possessing  the  somatic 
conditions  here  noted  should  pay  particular  attention  to  early 
hygienic  welfare. 


Fig.  70. 


The  type  of  the  antrum  (which  depends  on  the  variations  in 
evolution  of  the  face  and  the  further  variations  dependent  on  the 
nature  of  the  transitory  structures  with  which  it  is  connected 
as  well  as  on  the  periods  of  evolutionary  stress)  must  be 
extremely  variable.  It  is,  hence,  not  surprising  that  as  I  have 
pointed  out  nearly  a  decade  ago  the  variability  of  the  antrum 
cannot  well  be  overestimated.  In  a  general  way  it  may  be  said 
the  length,  height,  location  and  width  is  governed  by  the  shape 
of  the  face  and  by  the  type  of  the  nose  and  of  the  superior  max- 


198 


IRREGULARITIES    OF    THE    TEETH. 


ilia.  The  shape  and  position  of  the  antrum  hence  vary  widely. 
Thus  in  one  case  the  cavity  may  be  very  small  and  resembles  a 
crescent  with  its  concavity  toward  the  nasal  wall,  its  convexity 
toward  the  molar  process.  It  may  not  be  large  enough  to  admit 
the  end  of  the  little  finger  and  may  not  extend  as  far  laterally 
as  the  inferior  orbital  opening.  The  oppoiste  side  may  be  similar 
in  shape  and  extend  just  beyond  this  opening.  Sometimes  the 
antrum  upon  one  side  will  be  very  long  while  that  upon  the 
other  is  very  small.  Usually  the  nasal  cavity  will  be  carried  over 
nearly  one-half  of  its  size  to  the  side  of  the  smallest  antrum. 
There  is  sometimes  soft,  cancellated  bone  extending  from  the 
alveolar  process  into  and  filling  the  antrum,  leaving  a  number 


of  small  openings  or  sinuses  which  resemble  the  ethmoidal  cells. 
In  these  cases  the  contour  of  the  face  is  also  very  much  dis- 
figured, a  drill  passed  through  the  alveoli  of  the  first  and  second 
bicuspids  would  not  reach  an  opening. 

Although  the  antrum  is  usually  regarded  as  a  triangle  it 
assumes  even  in  normal  subjects  a  great  variation  from  this 
shape.  The  variations  which  may  occur  are  best  illustrated  in 
the  contrasts  between  the  following  cases.  The  first  three  have 
nothing  degenerate  recorded  in  their  history. 

In  Fig.  yi  is  seen  a  jaw  and  nasal  bone  of  a  person  certainly 
in  later  life.  After  all  the  teeth  had  been  removed  absorp- 
tion of  the  external  surface  of  the  alveolar  process  had  been 
proceeding  for  many  years.   The  roundness  of  the  alveolar  pro- 


ADOLESCeNT    NEUROSES    OF    NASAL    AND    FACIAL    RONFS. 


I'M) 


cess,  the  ridge  of  bone  in  the  vault  and  the  vault  itself  indicate 
this  to  be  the  case.  An  alveolar  process  the  size  and  shape 
illustrated  here  could  only  develop  with  the  second  set  of  teeth. 
It  will  be  observed  the  left  antrum  is  unusually  large;  that  it 
extends  up  to  and  encroaches  upon  the  left  orbital  cavity  and 
quite  a  distance  along  the  inner  border.  It  also  encroaches  upon 
the  left  nasal  cavity  and  downward  into  the  alveolar  process. 
The  right  antrum  is  very  small  as  a  result  of  which  the  alveolar 
process  is  very  large  and  extends  quite  a  distance  into  the  floor 
of  the  nose.  To  compensate  for  this  want  of  harmony  in  the 
development  of  the  antrum,  the  turbinated  bones  have  become 
enlarged,  and,  although  the  nasal  cavities  have  developed  con- 


Fig.  72. 

siderably  to  the  right  of  the  face,  all  the  bones  of  the  nose  have 
so  arranged  themselves  there  are  uniform  spaces  between  them. 
If  the  teeth  in  this  individual  remain  the  usual  number  of  years 
(this  illustration  represents  a  person  from  forty-five  to  sixty- 
five  years  of  age),  the  only  absorption  that  could  possibly  take 
place  would  be  at  the  outer  border  of  the  alveoli. 

Fig.  72  not  only  shows  the  antra  extending  toward  the 
median  line  upon  both  sides  encroaching  upon  the  nasal  cavity, 
but  there  are  also  ridges  of  bone  and  septa  extending  through 
the  cavity.    This  is  likewise  the  case  in  Fig.  71. 

Case  I  is  that  of  a  prostitute.  Width  of  dental  arch,  2.25. 
The  antrum  upon  the  right  side  extends  back  as  far  as  the  third 


200  IRREGULARITIES    OF    THE    TEETH. 

molar,  forward  to  the  canine  eminence  from  the  lower  border 
of  the  alveolar  process  to  the  floor  of  the  orbit,  the  cavity  was 
triangular  in  shape,  the  apex  being  downward  at  the  alveolar 
process ;  the  base  being  the  floor  of  the  orbit.  Its  length  of  the 
■  lower  part  was  1.50,  at  the  upper  1.75,  height  at  the  posterior 
part  1.75,  anterior  1.50,  width  below  .25,  at  the  upper  .62  of  an 
inch.  The  cavity  was  divided  into  two  parts  by  a  septum  of 
bone  .50  of  an  inch  in  height ;  another  septum  of  bone  extended 
horizontally  along  the  inner  side  opposite  the  inferior  orbital 
ridge.  The  left  side  of  the  superior  maxilla  was  very  much 
arrested  in  its  development  with  a  marked  protrusion  of  the 
alveolar  process  and  teeth  to  make  a  respectable  dental  arch  to 
correspond  to  that  of  the  other  side.  The  antrum  extended  from 
the  third  molar  forward  to  the  second  bicuspid.  The  length 
of  the  antrum  at  its  lower  part  measured  i;  upper  part,  1.50; 
height  at  the  anterior  part,  1.24;  at  the  posterior  part,  1.60; 
width  at  lower  border,  .36,  at  upper  border,  .50.  The  apex  in 
this  case  was  located  at  the  malar  process,  its  base  being  the 
outer  wall  of  the  nose.  A  drill  passed  into  the  cavity  of  the 
first  bicuspid  upon  the  right  side  would  penetrate  only  one-half 
of  the  antnun,  while  it  would  require  an  opening  of  the  second 
molar  to  drain  the  posterior  cavity.  In  either  case  the  drill 
would  have  to  travel  only  about  .25  an  inch  from  its  outer 
border.  If  a  drill  were  carried  into  the  antrum  at  the  anterior 
root  of  the  first  permanent  molar  upon  the  left  side,  it  would 
have  to  pass  .75  of  an  inch  to  reach  it. 

Case  II  is  that  of  an  Irish  epileptic  degenerate.  Width  of 
dental  arch  2.75;  vault  is  .84  in  height;  jaws  are  very  large  and 
massive.  The  antrum  upon  the  right  side  extends  from  the 
posterior  surface  of  the  third  molar  forward  at  the  lower  border 
to  the  anterior  root  of  the  first  permanent  molar,  at  the  upper 
border  on  a  line  with  canine  eminence.  Over  the  root  of  the 
second  bicuspid  there  is  a  very  marked  depression,  showing  the 
walls  of  the  antrum  unite  at  that  point.  The  cavity  is  almiost 
square,  as  will  be  seen  by  the  figure ;  length  of  lower  border,  1.12 
of  an  inch;  upper  border,  1.52  of  an  inch;  height  of  anterior 
part,  1.25;  posterior,  1.20;  width  below,  .75;  above,  .80.  To 
reach  the  antrum  at  the  second  bicuspid  the  drill  would  have  to 


ADOLESCENT     NEUROSES    OF    NASAL    AND    FACIAL    BONES.       201 

travel  1.25  from  the  lower  border  of  the  alveolar  process;  at  the 
anterior  root  of  the  first  molar  .75  from  lower  border.  The 
antrum  upon  the  left  side  extended  .50  of  an  inch  back  of  tlie 
second  molar  (the  third  molar  not  being  present),  forward  to  a 
point  over  the  root  of  the  second  bicuspid ;  the  upper  part 
extended  as  far  as  the  canine  eminence.  Length  of  lower  border, 
1.25;  upper,  1.75;  height  anterior,  7;  posterior,  1.25;  width,  .75; 
lower  border,  .78 ;  upper  border,  .80.  To  reach  the  antrum  at 
second  bicuspid  the  drill  would  have  to  pass  i,  with  dif^culty 
in  reaching  it ;  at  anterior  root  of  first  molar,  .84.  Both  cavities 
are  free  from  septa. 

Case  III  is  that  of  a  criminal.  The  third  molar  was  never 
present  upon  the  right  side.  The  antrum  therefore  extended 
.50  beyond  the  second  molar  forward  as  far  as  the  anterior  root 
of  the  first  permanent  molar  on  the  upper  border  to  a  point 
above  the  canine  eminence.  This  cavity  possesses  a  very  pecu- 
liar shape,  as  will  be  noticed  in  the  figure.  Length  of  the  lower 
border,  i;  upper,  .84;  triangular  in  different  directions.  First 
apex  at  outer  surface  of  malar  bone  base  outer  plate  of  the 
nose ;  second  apex  anterior  near  the  nose  and  base  toward  pos- 
terior surface.  The  roots  of  the  first  and  second  molars  pene- 
trate the  antrum  as  in  illustration.  The  antrum  could  only  be 
reached  by  going  through  the  outer  plate  of  the  alveloar  process 
of  the  first  permanent  molar.  The  antrum  upon  the  left  side 
extended  from  the  posterior  surface  of  the  second  molar  forward 
to  the  first  permanent  molar.  Length  of  lower  border,  1.25; 
upper,  1.75;  height  anterior,  .75;  posterior,  1.25;  width  lower, 
.50;  upper,  .60.  This  was  a  very  remarkable  cavity.  The  roots 
of  the  second  and  third  molars  penetrated  the  floor  of  the  cavity 
abscess  had  appeared  upon  the  buccal  roots  of  the  first  molar 
without  injury  to  the  floor  of  the  antrum.  The  outer  wall  of 
the  nose  had  bulged  into  the  antrum  in  its  entire  length  and 
width  from  the  lower  turbinated  bone  to  the  floor  of  the  nose. 
The  inner  and  outer  walls  of  the  antrum  had  become  united  at 
about  its  middle  by  a  septum  making  two  distinct  cavities. 

Case  IV  is  that  of  a  pauper.  The  antrum  upon  the  right  side 
extended  .50  of  an  inch  beyond  the  third  molar  forward  at  the 
lower  border  as  far  as  the  second  bicuspid ;  at  the  upper  border 


202  IRREGULARITIES    OF    THE    TEETH. 

to  a  point  over  the  canine  eminence.  The  apex  of  the  triangle 
in  this  case  is  located  at  the  junction  of  the  wall  of  the  nose 
and  floor  of  the  orbits.  The  base  was  formed  by  the  outer 
surface  and  malar  process,  a  ridge  dividing  the  anterior  part  of 
the  antrum  into  two  cavities  extends  from  the  floor  of  the  orbit 
down  about  half  the  depth  of  the  antrum  at  a  point  of  exit  of 
the  naterior  orbital  nerve  and  artery.  The  outer  wall  of  the 
nose  curves  into  the  antrum  filling  it  about  one-third  full.  It 
will  be  seen,  therefore,  the  cavity  is  very  irregular  in  shape. 
Its  length  at  the  lower  border  is  1.12;  upper  border,  1.38; 
height  anterior,  .75  ;  posterior,  1.25.  with  lower  border  36,  upper 
I  inch.  The  molar  teeth  extend  into  the  floor  of  the  cavity. 
Arrest  of  development  of  the  maxillary  bone  upon  the  left  side 
necessarily  causes  the  antrum  to  be  much  smaller  than  upon  the 
right  side.  Like  the  right  antrum  it  extends  .60  of  an  inch 
beyond  the  molar,  its  lower  border  extends  forward  to  the 
anterior  root  of  the  first  permanent  molar,  its  upper  border  to  a 
point  over  the  cuspid  teeth.  Length  of  lower  border,  i  ;  upper, 
1.25;  height  anterior,  .75;  posterior,  1.25;  width  lower  edge, 
.25  ;  upper,  .92.  The  palatine  roots  of  the  first  and  second  molars 
penetrate  the  floor  of  the  antrum. 

Case  V  is  that  of  a  prostitute.  The  right  antrum  is  very  small 
and  extends  back  to  the  posterior  surface  of  the  second  molar, 
the  third  molar  not  being  present  From  the  lower  border  of 
the  antrum  to  the  lower  border  of  the  alveolar  process  is  .75 
of  an  inch,  the  roots  of  the  teeth  therefore  do  not  reach  within 
.25  of  the  floor  of  the  cavity.  The  length  of  the  lower  border 
is  .75;  upper,  1.12;  height  of  the  antrum,  .60;  posterior,  i; 
width  of  lower,  .25;  upper,  i.  A  septum  extends  the  entire 
length  of  the  outer  and  inner  walls  except  a  space  about  the 
size  of  a  lead-pencil  dividing  the  antrum  into  almost  two  dis- 
tinct cavities.  The  left  antrum  extends  to  the  posterior  border 
of  the  third  molar ;  the  cavity  is  slightly  larger  than  the  other 
although  the  alveolar  process  is  just  as  large  and  therefore  the 
anterior  border  so  far  as  the  teeth  are  concerned  has  no  relation 
to  this.  The  length  of  the  lower  border,  .86 ;  anterior,  i ;  width, 
.28;  upper,  1.20.  This  cavity  contains  a  number  of  septa  run- 
ning in  every  direction.     The  nasal  bone  bends  inward  and  in 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.       203 

every  way  shows  stigtnata  of  degeneracy.  If  a  drill  were  to  be 
carried  into  the  antrum  through  the  roots  of  the  bicuspid  it 
would  have  to  travel  .60  of  an  inch  and  then  would  not  reach  the 
lowest  point.  We  are  not  warranted  in  making  openings  into  the 
antrum  through  the  root  canals  of  the  molars  because  they 
rarely  incline  in  the  direction.  The  drill  would  pass  either  into 
the  floor  of  the  nose  or  out  at  the  cheek. 

The  following  figures  here  illustrate  stigmata  of  the  antra  and 
the  difficulty  of  always  reaching  the  floor  of  the  antrum  by 
passing  a  drill  up  through  the  alveolus  for  the  purpose  of  drain- 
age. In  Fig.  60  the  left  antrum  is  seen  to  be  excessively  devel- 
oped. The  base  of  the  cavity,  located  at  the  floor  of  the  orbit, 
the  apex  near  the  borders  of  the  alveolar  process,  extends  quite 
a  distance  toward  the  median  line  and  under  the  nasal  cavity. 
It  even  encroaches  upon  the  left  nasal  cavity  at  its  upper  border. 
A  drill  would  pass  without  trouble  into  this  cavity  through  the 
palatine  or  even  buccal  roots  of  any  of  the  molar  teeth.  Quite 
a  different  state  of  things  is  noticed  upon  the  right  side.  The 
nasal  cavity  is  carried  over  and  occupies  the  space  where  the 
antrum  should  be  located.  The  antrum  is  very  small  upon  the 
inner  surface  of  the  malar  process  under  the  eye.  A  drill  passed 
through  the  alveolus  would  certainly  enter  the  floor  of  the  orbit. 
In  Fig.  61  both  antra  are  seen  so  located  that  the  drill  passing 
through  the  alveoli  would  not  penetrate,  but  in  both  cases  the 
floors  of  the  nasal  cavities  would  be  punctured.  The  left  antrum 
(Fig.  62)  is  almost  entirely  obliterated.  Stigmata  are  not  only 
seen  in  the  antra,  but  also  throughout  the  nasal  bones  and 
ethmoidal  cells. 

To  reach  both  antra  by  drilling  through  the  alveoli,  could 
only  be  accomplished  with  difficulty.  The  cross  section  (Fig.  63) 
was  taken  so  far  forward  that  description  of  the  antra  is  out  of 
the  question. 

In  Fig.  64  the  antra  are  seen  to  be  so  small  as  to  be  almost 
obliterated.  The  nasal  cavities,  however,  are  so  large  that  the. 
floors  of  these  cavities  would  be  punctured  if  a  drill  was  passed 
through  the  alveoli. 

Some  years"  ago  I  recorded  a  case  in  which  a  patient,  had 
an  opening  drilled  through  the  cavity  of  the  second  bicuspid 


204  IRREGULARITIES    OF    THE    TEETH. 

to  relieve  the  antrum,  and  the  drill  passed  into  the  floor  of  the 
nose.  At  that  time  it  occurred  that  there  was  gross  ignorance 
on  the  part  of  the  operator  as  to  the  location  of  the  antrum. 
An  opinion  I  have  since  changed. 

On  examination  of  skulls,  I  have  discovered  some  eight  cases 
where  the  floor  of  the  nose  was  so  wide  and  the  facial  bones 
so  deformed  that  the  long  axis  of  the  roots  were  directed  into 
the  floor  of  the  nose.  In  each  case  the  floor  of  the  nose  would  be 
perforated  were  the  operator  to  drill  through  the  palatine  buccal 
roots  of  the  first  or  second  molars.  I  have  frequently  observed 
arrest  of  development  of  the  maxillary  bone  on  a  line  with  the 
alffi  of  the  nose,  when  the  alveolar  process  (in  order  that  the 
teeth  might  antagonize  with  the  lower  teeth)  extended  outward 
to  such  an  extent  that  the  apices  of  the  roots  of  the  bicuspids 
would  point  entirely  outside  of  the  line  of  the  antrum.  Hence 
the  alveoli  are  not  a  reliable  route  by  which  to  reach  the  lowest 
point  in  the  floor  of  the  antrum,  nor  is  the  operator  sure  of 
reaching  it  at  all.  It  is  easy  to  see  how  in  a  very  few  cases  the 
development  of  the  antrum  and  nasal  cavities  might  be  such, 
together  with  the  thinness  of  the  alveolar  process,  that  the  roots 
of  the  teeth  may  penetrate  the  floor  of  the  antrum  (Fig.  73). 
These  cases,  however,  are  very  rare.  In  most  cases,  owing  to 
the  thickness  of  the  alveolar  walls  and  the  position  of  the 
antrum,  the  roots  of  the  teeth  will  not  reach  it.  The  roots  of 
first  and  second  bicuspids  almost  never  enter  the  floor  of  the 
antrum.  The  roots  of  the  first  permanent  molar  in  its  relation 
to  the  antrum  are  such  that  it  is  almost  impossible  to  penetrate 
them. 

Of  the  11,000  skulls  examined  for  deformities,  only  3,000 
were  in  a  broken  condition,  so  that  the  antra  could  be  exam- 
ined, making  6,000  antra  in  all.  Of  this  number  1,274,  or  about 
21  per  cent,  had  abscessed  molar  teeth.  Of  this  number  76,  or 
about  6  per  cent,  extended  into  and  apparently  discharged  into 
the  antrum.  As  specialists  were  unknown  among  the  people 
whose  skulls  were  examined,  a  larger  percentage  of  abscessed 
cavities  would  be  found  than  at  present.  Septa  were  found  in 
963  cases.  These  ranged  all  the  way  from  a  simple  ridge  run- 
ning along  the   floor  to  a  partition   extending  two-thirds   the 


ADOLESCENT    NEUROSES    OF    NASAL    ANd'fACIAL    BONES.      205 

height  of  the  cavity.  Again,  several  septa  occurred  in  all  direc- 
tions, which  gave  the  appearance  of  ethmoidal  cells  extending 
throughout  the  entire  cavity. 

In  the  treatment  of  367  cases  of  pulpless  teeth,  in  connection 
with  the  superior  molars,  in  the  past  twenty-two  years,  only 
three  cases  of  diseased  antrum  were  noticed,  making  less  than 
three  per  cent  of  diseased  antrum. 

M.  H.  Fletcher  found  in  224  cases  of  pulpless  molar  teeth, 
only  one  case  of  pus. in  the  antrum.  Antral  difficulties  are  hence 
very  rarely  connected  with  the  teeth.  Most  cases  of  diseased 
antrum  seek  the  rhinoloeist  because  most  are  connected  with 


Fig.  73. 

the  nasal  lesion,  hence,  the  dental  surgeon  sees  but  a  small  per- 
centage of  actual  cases.  Disease  of  the  antrum  is  very  rarely 
due  to  diseases  of  the  teeth.  Like  diseases  of  the  mucous  mem- 
brane of  the  nose,  disease  of  the  mucous  membrane  of  the  antra 
is  to  a  great  extent  the  result  of — first,  a  very  abnormal  develop- 
ment of  the  osseous  system,  and,  second,  of  improper  tonicity 
of  the  nervous  system  acting  upon  a  badly  developed  mucous 
membrane. 

Disease  of  the  antrum,  in  my  experience,  is  most  often 
observed  in  persons  who  have  been  exposed  to  cold  weather, 
and  that' both  sides  are  more  or  less  affected.    This  was  a  com- 


206  IRREGULARITIES    OF    THE    TEETH. 

mon  occurrence  with  epidemic  la  grippe.  If  only  one  side  is 
involved,  the  other  frequently  is  or  has  been  at  a  previous  time. 
In  the  large  number  of  skulls  examined,  the  floor  of  the  antrum 
was  found  to  be  nearly  on  a  level  with  the  line  of  the  alveolar 
process  as  far  as  the  anterior  roots  of  the  first  molar.  It  then 
curves  upward  and  forward,  terminating  at  a  point  above  the 
apex  of  the  root  of  the  cuspid  tooth.  That  being  the  case,  a 
drill  passed  through  the  alveoli  of  the  first  and  second  bicuspid 
would  reach  a  point  quite  a  distance  above  the  floor  of  the 
antrum.  From  what  has  been  said  in  regard  to  the  shape  and 
location  of  the  antrum,  it  will  be  seen  that  the  lowest  and  safest 
locality  to  puncture  the  antrum,  is  just  between  the  roots  of  the 
first  permanent  molar  and  the  root  of  the  second  bicuspid.  The 
opening  should  be  made  with  a  drill  directed  backward  and 
inward.  This  part  is  nearly  always  on  a  level  with  the  floor  of 
the  antrum,  and  the  outer  wall  is  very  thin  at  that  point.  The 
patient  should  be  requested  to  lie  first  upon  the  back  and  then 
upon  the  face.  Should  there  be  any  septa  the  fluid  will  in  this 
jvay  be  easily  drained. 

M.  H.  Fletcher,^  of  Cincinnati,  has  said  with  equal  truth  and 
clearness,  in  a  paper  read  before  the  Section  on  Oral  and  Dental 
Surgery  of  the  American  Medical  Association,  June  i,  1893: 

"The  summing  up  or  rationale,  then,  of  the  evidence  here- 
with seems  to  be.  first,  that  the  anaJ:omical  relations  between  the 
teeth  and  the  antrum  are  not  generally  understood,  since  the 
sections  here  shown  give  evidence  of  much  more  cancellous 
bone  than  is  usually  considered  to  exist. 

"Second.  Small  septa  are  present  in  a  large  per  cent  of  cases, 
and  these  septa  or  ridges  have  no  direct  relation  to  the  position 
of  the  teeth. 

"Third.  Statistics  seem  to  show  that  a  very  small  per  cent 
of  abscessed  teeth  have  any  connection  whatever  with  the 
antrum;  this  per  cent  probably  not  being  over  seven  to  ten. 

"Fourth.  The  evidence  seems  to  indicate  that  the  protru- 
sion of  the  teeth  into  the  cavity  is  very  largely  the  exception 
instead  of  the  rule,  and  that  if  they  do  protrude,  it  is  not  evi- 


'  Journal  of  the  American  Medical  Association,   1893. 


ADOLESCENT    NEUROSES    OF    NASAL    AND    FACIAL    BONES.      207 

dence  that  an  alveolar  abscess  would  break  there,  since  these 
tubercles  are  usually  formed  of  dense,  hard  bone. 

"Fifth.  A  number  of  cases  have  been  found  where  there  is 
a  perforation  of  the  bone  by  the  apices  of  the  teeth  and  no 
protrusion ;  but  that  these  apices  are  simply  covered  with 
mucous  membrane,  thereby  the  teeth  may  be  afifected  by  inflam- 
mation of  the  antrum,  causing  their  death  and  loss  or  a  continu- 
ance of  the  trouble  in  the  antrum  by  their  presence  in  conse- 
quence of  this  special  feature  of  the  anatomy,  and  that  pulpless 
and  inflamed  teeth  are  thought  to  be  the  usual  cause  of  antral 
trouble,  where  the  reverse  is  often  probably  the  case. 

"Sixth. .  That  seemingly  the  best  place  to  perforate  the 
antrum  of  Highmore  for  pus,  is  between  the  apices  of  the  second 
bicuspid  and  first  molar." 

"Since  writing  this  paper,  Dr.  Fletcher  examined  an  addi- 
tional 400  skulls,  and  finds  the  figures  changed  in  regard  to  the 
per  cent  of  abscessed  molars  which  are  connected  with  the 
antrum.  In  500  skulls  (making  1,000  antra)  he  found  252  upper 
molars  abscessed,  making  twenty-five  per  cent  of  antra  which 
have  abscesses  in  this  locality,  or  every  fourth  antrum.  This 
per  cent  is  probably  smaller  than  it  should  be,  since  many  teeth 
were  lost  and  the  alveolar  process  absorbed  away,  and  undoubt- 
edly some  of  these  lost  teeth  have  been  abscessed.  Out  of  these 
252  possible  cases,  perforation  into  the  antrum  was  found  only 
twelve  times ;  thus  showing  over  four  and  one-half  per  cent,  or 
about  one  in  every  twenty-one  of  the  abscessed  teeth  in  this 
locality,  which  are  connected  with  the  antrum." 


CHAPTER  XIX. 


DEVELOPMENTAL  NEUROSES  OF  THE  EYE. 

In  the  typical  human  infant  the  eyes  are  larger  than  in  the 
adult.  In  this  last  particular  the  human  infant  resembles  the 
lemurs  and  thus  retains  an  embryonic  tendency  which,  as  else- 
where shown,  may  remain  unchecked  and  result  in  unusually 
large  orbits,  or  the  orbits  may  pass  through  this  lemurian  stage 
to  reach  and  even  exceed  the  anthropoid  in  smallness  and  close- 
ness together. 

The  eye,  according  to  Lee  Wallace  Dean,i  during  its  develop- 
ment, passes,  just  as  the  brain  does,  through  stages  which  resem- 
ble and  correspond  to  the  eyes  of  lower  animals.  If,  owing  to 
an  affection  of  its  governing  center,  its  development  is  interfered 
with  or  stopped,  the  eyes  correspond  more  or  less  to  those  of  the 
lower  animals,  as  in  persistent  hyaloid,  colobomata,  microph- 
thalmia, etc.  Neither  the  degenerate  human  brain  nor  the  unde- 
veloped eye  resemble  exactly  the  brain  or  eye  of  the  lower 
animal.  While,  as  I  have  elsewhere-  shown,  there  is  a  conflict 
as  to  the  primitive  type  of  the  vertebrate  between  morphologists 
represented  by  Howard  Ayres  (who  claims  the  eyes  were  derived 
from  the  median  eye  of  the  ascidian  lancelet)  and  Semper  (who  is 
of  the  opinion  that  the  existing  vertebrates'  eyes  represent  the 
paired  eyes  of  a  hypothetical  annelid  precursor),  still  both  opin- 
ions are  reconcilable  through  study  of  the  ascidian  and  lancelet 
eye  collated  with  cyclopian  and  triophthalmic  (three-eyed) 
degeneracies  in  man,  the  human  eye  and  the  third  eye  of  rep- 
tiles, like  the  hatteria  of  New  Zealand.  The  eye  of  the  ascidian 
tadpole  agrees  fundamentally  with  the  type  of  eye  peculiar  to  the 
vertebrates  in  that  the  retina  is  derived  from  the  wall  of  the 
brain.  On  this  account  it  is  called  a  myolonic  eye.  In  the 
typical  invertebrate  eye,  on  the  contrary,  the  retinal  cells  are 
differentiated  from  the  external  ectoderm. 

1  Ophthalmic  Record,  Sept.,  igoo. 

2  Degeneracy,   Op.   Cit. 

208 


l)K\i:i.()l'MKNTAI.    NEUKOSKS   OF    TlIK    KVE.  ;j( )!) 

llic  ascidian  eye  differs  essentially  from  llic  paired  eyes  of 
(!io  oraniati'  (skulled)  vertebrates  in  that  the  lens  as  well  as  the 
lelina  is  (KriM'd  frou!  \\\v  wall  of  the  brain.  The  lens  of  the 
lateral  eye  ot  the  vertebrates  is  deri\e(l  bv  an  invagination  of 
the  extoderni,  which  meets  and  tits  in  the  retinal  cup  at  the  end 
of  the  ojitic  Ni'sii-jc.  The  ascidian  eye,  however,  as^rees  as  to  lens 
origin  with  the  ])arietal  or  i)in(.'al  eye  of  the  lizard,  in  which  the 
lens  is  likew  ise  derived  from  cells  which  form  part  of  the  wall  of 
the  cerebral  outgrt)vvth  that  gives  rise  to  the  pineal  body. 

The  pineal  Ijody  is  a  remarkable  rudimentary  structure  whose 
constant  presence  in  all  groups  of  vertebrates  forms  such  an 
eminently  characteristic  median  outgrowth  from  the  dorsal  wall 
of  the  brain  (thalamencephalonj,  the  distal  extremity  of  which 
dilates  into  a  vesicle  and  becomes  separated  from  the  proximal 
jiortion.  The  distal  vesicle  becomes  entirely  constricted  off  from 
the  primary  epiphysial  (pineal)  outgrowth  of  the  brain  and  the 
parietal  nerve  does  not  represent  the  primitive  connection  of  the 
]iineal  eye  with  the  roof  of  the  brain  but  arises  quite  inde- 
pendently of  the  proximal  portion  of  the  epiphysis. 

The  remote  ancestors  of  the  vertebrates  possessed  a  median 
unpaired  myolonic  eye  which  was  subsecpiently  replaced  in  func- 
tion by  the  evolution  of  the  paired  eyes.  The  cyclopic  condi- 
tions occur  very  frequently  among  human  monstrosities,  much 
more  frequently  than  among  animals.  Hannover  claims  this  is 
due  to  the  fact  that  human  monstrosities  are  much  more  fre- 
qviently  recorded.  Of  the  120  cases  of  human  cyclopia,  56  pre- 
sented other  evidences  of  degeneracy  than  cyclopic  conditions 
and  60  had  neuropathies  or  other  taint  in  the  ancestry.  Accord- 
ing to  Dareste  the  production  of  a  single  eye,  the  changes  in 
the  structure  of  the  mouth,  the  atrophy  and  abnormal  situation 
of  the  olfactory  apparatus  and  of  the  vesicle  of  the  hemispheres 
all  result  from  an  arrest  of  development.  The  determining 
influences  must  be  exerted  very  early  in  the  life  history  of  the 
embryo. 

According  to  Hannover,  coincidently  occurs  hydrocephalus 
and  harelip,  imperfect  genital  development  and  allied  arrests, of 
development.  J.  R.  Folsom,  of  Cecil,  Georgia,  has  reported  a 
female  born  alive  to  a  negro  multipara,  which  died  two  hours 

15 


210 


IRREGULARITIES    OF    THE    TEETH. 


after  birth.  The  eye  was  centrally  located  in  the  forehead  on 
a  line  with  the  nose.  The  brow  was  a  complete  arch,  as  was  the 
upper  eyelid.  The  lower  lid  had  a  mark  midway  indicating  an 
attempt  at  division.  The  nasal  bones  were  wanting.  The  soft 
part  of  the  nose  destitute  of  the  orifice  hung  over  the  mouth, 
which  was  completely  covered.  The  chin  was  recedent.  In  a 
case  reported  by  C.  Phisalix,  the  nose  was  wanting.  Its  place 
in  the  median  line  was  occupied  by  a  single  eye ;  on  the  hori- 
zontal diameter  were  two  pupils  separated  by  a  narrow  space. 
Landolt,  discussing  a  case  reported  by  Valude,. claims  that  while 
in  cyclopic  eyes  all  the  parts  may  be  doubled  or  unite  in  every 
degree,  there  is  never  a  single  lens  or  double  vitreous.     Bock 


Fig.  74 

and  others,  however,  describe  cases  in  which  the  eye  had  not 
been  formed  by  the  conglomeration  of  two  separately  devel- 
oped eyes,  but  is  a  single  developed  eye ;  the  other  being  want- 
ing entirely.  Bruce  reports  a  cyclops  in  which  there  was  a  single 
socket  for  the  eye,  of  a  lozenge-shape,  situated  in  the  lower 
middle  of  the  forehead.  The  socket  was  furnished  with  two  pairs 
of  eyelids,  upper  and  lower.  The  eye  was  found  to  consist  of  two 
rudimentary  retinae  apparently  springing  from  a  single  optic 
vesicle.  The  nose  was  represented  by  a  short  process  attached 
to  the  forehead,  above  the  median  eye.  The  cyclops  illustrated 
(Fig.  74),  was  born  to  a  seventeen-year-old  neuropathic  primi- 


DEVELOPMKNTAL  NEUROSES  OF  THE  EYE.  211 

para  after  a  protracted  labor.  The  child  was  living,  but  killed 
by  pressure  on  the  funis.  The  mouth  contained  an  ivory  tusk- 
like tooth  at  each  corner.  There  was  mane-like  hair  around 
the  neck.  Cyclopia  is  very  frequently  associated  with  the  absence 
of  both  the  internal  and  external  ear  and  with  synotia  (joined 
ears).  Tn  tlu-  lri(»])hlhalniic  cases  the  three  eyes  are  usually 
separate;  two  occup}ing-  the  usual  position  while  the  third  is 
situated  as  illustrated  in  the  case  cited.  Ninety  families  of  degen- 
erates, averaging  eleven  children  each,  had  five  cases  of  cyclopia. 
Degeneracy  which  affects  so  deeply  the  development  of  the 
eye  natural!}-  tends  to  evince  itself  in  other  anomalous  state  in 
the  organ.  As  excessive  asymmetry  of  the  body  is  one  of  the 
most  noticeable  of  the  stigmata  of  degeneracy  it  is  not  aston- 
ishing to  find  that  this  asymmetry  expresses  itself  both  in  the 
position  as  well  as  in  the  size  and  structure  of  the  eye.  As 
Kiernan  pointed  out  twenty-three  years^  ago,  asymmetrical 
irides  are  exceedingly  frequent  in  the  types  of  insanity  due  to 
hereditary  defect.  This  observation  has  since  been  confirmed 
by  Fere,"*  not  only  as  to  the  insane  but  as  to  other  classes 
of  degenerates.  The  conditions  of  the  eye  known  as  microph- 
thalmia (small  eye),  macrophthalmia  (big  eyes)  and  anophthal- 
mia (absence  of  eyes)  are  found  quite  frequently  in  degenerate 
families.  Corectopia  (displacement  of  the  pupil  so  that  it  is 
not  in  the  center  of  the  iris)  often  exists.  Coloboma  (eye  fissure) 
is  also  not  infrequent  among  degenerates.  These  vary  greatly 
in  situation  and  general  results.  The  iris  is  sometimes  com- 
pletely absent"  on  one  or  both  sides  (aniridia).  Beside  these 
anomalies,  diseased  conditions  like  retinitis  pigmentosa,  con- 
genital cataract  and  the  macular  degeneracy  (reported  by  C. 
P.  Pinckard^)  are  far  from  infrequent  expressions  of  degenerate 
taint  of  the  eye.  The  organ  in  this  particular  obeys  the  general 
law  that  degeneracy  may  show  itself  in  the  minute  change  result- 
ing in  disturbances  of  functions  or  in  that  producing  disease  or 
finally  atavism.     The  defects  of  the  eye  requiring  glasses  are 

3  Journal  of  Nervous  and  Mental  Disease,  1878. 
*  La  Famille  Nervopathique. 
5  Medicine,  1898. 


212 


IRREGULARITIES    OF    THE    TEETH. 


exceedingly  frequent  in  degenerates  and  aggravate  their  mor- 
bidity. 

The  following  cases  reported  b\'  T..  W.  Dean/'  are  of  interest 
here  since  they  demonstrate  two  marked  deformities  of  arrest 
of  development  of  the  upper  and  lower  jaws : 

Case  XIV.  Lillie  L.  (Fig.  75).  Female,  age  14.  Patient's 
people  are  exceedingly  poor  and  so  ignorant  as  to  make  it 
impossible  to  get  any  reliable  family  history.  There  are  four 
sisters  and  three  brothers,  all  poor  and  ignorant.  The  patient 
is  idiotic.  She  has  a  retreating  forehead,  and  exceedingly  crooked 


Fig.  75. 

nose,  a  very  long  neck  and  an  exceedingly  small,  retrusive  jaw, 
the  lower  incisors  striking  at  least  one-half  inch  behind  the 
upper.  The  teeth  are  exceedingly  irregular.  The  two  left  upper 
incisors  are  large,  the  two  others  very  small.  Of  the  lower 
incisors,  the  two  central  ones  are  like  mice  teeth,  pointed  and 
sharp.  They  are  separated  at  their  bases,  but  come  together  at 
their  tops  at  an  acute  angle.  The  other  two  are  conical  and 
lie  each  parallel  to  its  neighbor.  Examination  of  eyes  reveals 
V — fingers  in  ^  M.  Eyes  small.  Nystagmus.  Fundi  apparently 
normal.     Diagnosis,  microphthalmus. 

"Op.  Cit. 


DEVELOPMENTAl,    NEUROSES    OF    THE    EYE. 


213 


Case  XV.  Ida  C.  (Fig.  76).  Female,  age  17.  Father  is 
deaf.  Could  obtain  no  history  of  degenerate  stigmata  in  mother. 
Has  four  sisters  living,  nine  dead.  Has  four  brothers  living 
and  one  dead.  Had  to  depend  on  patient  for  family  history.  The 
patient  is  exceedingly  dull.  It  is  impossible  for  her  to  learn. 
She  has  jaws  that,  at  the  junction  of  the  premaxillary  and  max- 


Fig.  7G. 


illary  bones,  present  a  well  marked  angle.  Her  teeth  are  conical. 
The  incisors  are  sharp  and  pointed ;  are  like  mice  teeth.  The 
ears  are  small  and  placed  high  up  on  the  head ;  she  is  almost  a 
typical  degenerate,  both  physically  and  mentally.  Examination  of 
the  eyes  reveals  Y — cannot  count  fingers,  but  sees  large  objects. 


CHAPTER  XX. 


DEVELOPMENTAL  NEUROSES  OF  THE  BONES  OF 

THE  EAR. 

Aural  affections  are  frequently  a  result  of  degeneracy,  exhib- 
iting itself  under  the  various  forms  of  deformity  impUcating 
the  auditory  apparatus.  Thus  total  absence  of  the  external  ear, 
as  well  as  embryonic  internal  ear,  occurs.  The  mere  fact  of  the 
exceedingly  primitive  structure  of  the  internal  auditory  mechan- 
ism necessitates  abnormal  or  defective  hearing  power.  To  this 
many  cases  of  congenital  deaf-mutism  owe  their  origin,- inas- 
much as  the  auditory  mechanism  is  not  in  a  condition  to  appre- 
ciate sound.  Even  though  the  individual  may  not  have  been 
born  deaf,  deaf-mutism  from  inability  to  appreciate  sound  occurs 
and  the  whole  auditory  apparatus  subsequently  degenerates. 
Sometimes  a  mental  taint  superadded  aggravates  the  case.  The 
absence  of  the  external  ears  and  even  closure  of  the  Eustachian 
tube  may  occur  without  deafness.^ 

Stigmata  of  the  bones  of  the  ear  occasionally  take  place. 
Taking  into  consideration  the  complicated  structure  of  which  the 
bone  and  sundry  parts  of  the  ear  are  composed,  lesions  of  the 
ear  must  be  attributed  to  such  deformities.  In  an  examination 
of  1,935  persons,  taken  as  they  come,  deformities  of  the  jaws, 
were  observed  (Table  XVHI). 

Of  143  cases  of  congenital  deaf  mutes.  93  per  cent  exhibited 
deformities  of  the  head,  face,  jaws  and  teeth. 

1  Gould  Anomalies,  page  261.  ' 


214 


CHAPTER  XXI. 


DEVELOPMENTAL    NEUROSES    OF   JAWS    OF   THE 
SEEMINGLY  NORMAL. 

The  mouths  of  i,ooo  school  children  over  twelve  years  of 
age  and  i,ooo  adults,  patients  and  friends,  were  examined  with 
the  following  results:  (Table  XIX).  There  were  fifteen  per 
cent  more  deformities  in  adults  than  in  children.  This  is 
accounted  for  in  two  ways:  (i)  That  as  people  grow  older 
slight  irregularities  of  the  teeth  'may  become  sometimes  more 
prominent,  owing  to  movement  and  permanent  arrangement  of 
the  teeth  later  in  life.  (2)  Some  of  those  examined  are  patients 
who  presented  deformities  that  alarmed  them.  The  percentage 
of  deformities,  however,  compares  favorably  with  the  percentage 
of  deformities  of  the  face.  Taken  as  a  w'hole  they  give  an 
approximate  idea  of  the  percentage  of  deformities  in  this  com- 
munity at  least.  The  facial  bones  may  become  excessively 
developed  or  arrested  while  the  jaws  remain  normal.  The  jaws 
may  be  deformed  and  the  face  remain  apparently  normal.  The 
percentage  is  from  twenty-five  to  tliirty-three  per  cent  less  than 
found  in  institutions  for  defectives. 


215 


CHAPTER    XXII. 


DEVELOPMEXTAL  XEUROSES  OF  THE  .MAXILLARY 

BONES. 

Excessive  gro^vth  of  bone-tissue  is  frequently  seen  in  connec- 
tion with  the  superior  and  inferior  maxillae.  It  may  be  a  natural 
growth  or  the  result  of  disease.  If  the  jaw  be  naturally  large, 
it  will  develop  gradually  and  will  not  attain  full  size  before  the 
age  of  from  twenty-six  to  thirty-six  years.  The  size  of  the  jaw 
corresponds  quite  closely  to  the  size  of  the  head,  other  things 
being  equal,  the  large  head  containing  the  large  jaw.  Occa- 
sionally, however,  there  is  a  very  small  jaw  in  a  very  large  head 
and  vice  versa.  The  upper  jaw  is  more  subject  to  morbid  influ- 
ences than  the  lower  jaw,  because  of  its  connection  with  the 
bones  ©f  the  head.  The  lower  jaw  rarely  exceeds  the  average  size. 
Constant  use  may  increase  the  size  of  the  jaws,  as  in  acrobats, 
especially  those  who  use  the  jaws  in  various  feats,  like  "the 
man  with  the  iron  jaw."  Jaws  of  tobacco-chewers,  singers, 
public  speakers  and  of  the  early  races  who  lived  upon  corn,  shell, 
roots,  etc.,  show  that  the  jaws  may  l)e  favored  in  size  develop- 
ment by  use. 

Enlargement  of  the  jaw-bones  occasionally  causes  dental 
irregularities.  This  may  occur  in  either  jaw,  but  generally  in  the 
upper.  It  may  be  due  to  hypertrophy  on  the  one  hand,  or  hyper- 
plasia upon  the  other,  to- osteitis,  periostitis,  continued  irritation 
drawing  blood  to  the  part,  in  some  cases  to  disease  of  the  antrum 
and  nasal  fossae,  producing  the  same  result.  Disease  of  the 
antrum  may  cause  either  periosteal  or  osteal  enlargements. 
Hereditary  syphilis  has  an  especial  predilection  for  the  bones, 
particularly  at  the  junction  of  epiphysis  and  diapliysis.  Growth 
of  the  teeth  does  not  proportionately  increase,  hence  consequent 
disproportion  between  the  teeth  and  jaws  necessarily  produces 
deformity.  The  forms  of  irregularities  of  the  teeth  that  co-exist 
with  crowded  arches  are  not  seen  in  enlarged  jaws.  Rachitis 
in  children,  whether  due  to  syphilis  or  not,  causes  hypertrophy 

216 


DKVEI.OI'IMF.NTAI,    N'KUROSES    OF    THE    MAXILLARY    RONES.        217 

and  hyperplasia  of  tlie  jaws.  The  hypertrophy  and  hyperplasia 
may  be  localized  in  some  portion  of  the  jaw,  causing  it  to  be 
imevenly  developed.  ;\s  illustrative  of  the  interesting  character 
of  some  of  these  conditions  described,  I  take  the  liberty  to 
present  a  few  cases  which  have  come  under  my  notice. 

Case  i^.  Arrest  of  development.  Girl  aged  ten  years. 
Father  and  mother  have  well  developed  jaws.  Consumption  on 
father's  side ;  cancer  on  mother's  side.  Child  scrofulous,  witli 
small  bones,  especial!}-  the  maxillae,  which  are  unusually  small. 
When  first  seen  the  teeth  of  both  jaws  (permanent  first  molars 
and  incisors,  tem])orary  cuspids  and  molars)  are  in  a  very 
crowded  condition.  The  teeth  are  normal  in  size.  With  such 
unusually  small  jaws  and  the  teeth  at  this  age  being  very 
crowded,  marked  \'  or  saddle-sha])ed  arches  were  prophesied. 
Four  years  later  the  jaws  were  arrested  in  their  development 
and  a  marked  V-shaped  arch  was  produced. 

Case  2.  Arrest  of  development.  Girl  aged  sixteen  years. 
\\'hen  quite  young  had  a  severe  attack  of  scarlet  fever  and  the 
arrest  of  the  development  of  the  bony  frame-work  resulted.  The 
jaws  were  unusually  small  and  the  teeth  are  crowded  to  such  an 
extent  that  the  cuspids  remain  outside  the  arch. 

Case  3.  Enlargement  of  the  superior  maxilla.  A  fourteen- 
year-old  boy  was  sent  to  me  for  an  opinion  in  regard  to  teeth 
which  were  found  of  the  normal  size.  Spaces  existed  between 
all  the  teeth  as  far  back  as  the  first  permanent  molars.  The 
bicuspids  were  not  fully  developed,  but  were  through  the  gum 
sufficiently  to  notice  their  position  in  connection  with  the  other 
teeth.  The  spaces  were  not  uniform,  those  between  the  incisors 
being  the  largest.  The  widest  space  was  between  the  central 
incisors ;  the  incisors  of  the  lower  jaw  coming  in  contact  with  the 
mucous  membrane  of  the  mouth  posterior  to  the  superior 
incisors. 

Case  4.  Hypertrophy  of  the  jaw.  A  nineteen-year-old 
patient  came  under  treatment  in  June,  1887.  When  fourteen 
years  he  received  a  blow  upon  the  side  of  the  jaw.  He  is 
scrofulous.  The  blow  produced  a  low  form  of  inflammation 
and  hypertrophv  of  the  bone   supervened.     The  teeth  of  that 

1  This  case  was  noticed  in  the  second  edition,  1890. 


218  IRKEGULARITIES    OF    THE    TEETH. 

side  of  the  jaw  were  carried  laterally  and  spaces  existed  between 
the  bicuspids  and  molars. 

Case  5.  Antrum  disease.  German-American  boy  aged 
seven  years.  Scrofulous.  Quite  a  deformity  was  noticed  upon 
the  left  side  of  the  face,  produced  by  the  bulging  of  the  antral 
wall.  Hypertrophy  of  the  alveolar  process  existed.  The  tem- 
porary teeth  on  the  left  side  of  the  upper  jaw  extended  beyond 
those  of  the  lower  jaw.  Upon  opening  into  the  antrum  a  thick, 
ropy  fluid  exuded.  After  three  months'  treatment  there  was  no 
improvement. 

The  superior  maxilla  is  influenced  to  a  greater  degree  by 
the  various  causes  of  jaw  deformities  than  the  inferior.  The 
bones  of  the  upper  jaw  are  in  direct  contact  with  the  other  bones 
of  the  body,  while  tlie  lower  jaw  develops  independently  and 
is  only  attached  at  its  remote  extremities  by  articulation.  The 
body  of  the  bone  is  free  to  develop  or  to  remain  dwarfed,  depend- 
ing v/holly  upon  its  nerve  and  blood-supply  for  its  nourishment. 
There  are  indications  that  the  superior  is  gradually  diminishing 
in  size.  The  inferior  maxilla,  although  under  the  same  influ- 
ences, has  a  powerful  factor  to  aid  preservation,  viz..  motion  and 
exercise.  The  question  naturally  presents  itself  as  to  what 
extent  certain  properties  of  the  jaws,  influenced  by  habit  (use), 
may  be  transmitted.  The  tissues  of  the  body,  especially  those 
of  the  osseous  and  muscular  systems,  possess  a  certain  degree 
of  plasticity,  by  which  they  are  enabled  to  change  their  weight 
or  shape.  This  quality  depends  upon  the  use  of  muscles  and 
bones.  Among  vertebrates  a  close  relation  exists  between  the 
muscles  and  the  bones  upon  which  they  are  inserted.  The 
union  is  made  up  of  tendons,  which  are  prolongations  of  the 
muscles  to  the  periosteum  and  the  periosteum  is  attached  to 
the  bones.  Powerful  muscles  and  large  bones  are  always  asso- 
ciated, exercise  developing  them  both  simultaneously.  As  out- 
ward changes  occur  in  the  life  of  human  beings  or  animals, 
adjustment  to  environment  tends  to  alter  the  physical  charac- 
teristics. These  changes  often  occur  through  such  gradual  mod- 
ifications that  from  one  generation  to  another  but  little  marked 
difTerence  is  noticed,  but  the  structure,  in  the  course  of  a  number 
of  generations,  will  §0  change  that  a  new  species  will  be  devel- 


DEVELOPMENTAL    NEUROSES    OF    THE    MAXILLARY    BONES.       219 

oped.  Any  animal  domesticated  from  a  wild  life  shows  this 
change.  The  negro  imported  from  Africa  will,  after  several 
generations,  have  a  less  prominent  jawbone,  more  prominent 
frontal  bone.  The  changes,  however,  are  more  gradual  in  the 
white  races,  after  intermarriage,  than  with  negro  cross-breeds. 
No  part  of  the  body  demonstrates  these  changes  so  forcibly 
as  the  superior  or  inferior  maxilla.  The  extremities  must  be 
measured  and  weighed  to  compare  the  two  halves  of  the  body. 
The  changes  in  the  shape  of  head  and  jaws  are  not  confined  to 
one  race  nor  to  past  generations  and  are  continually  progress- 
ing. 


Asymmetry  of  the  lateral  halves  of  the  maxillary  bones  exists 
in  the  present  era  of  the  human  race  and  prevails  to  a  greater 
extent  among  neurotics  and  degenerates  and  among  the  off- 
spring of  mixed  races.  Each  lateral  half  of  the  body  develops 
independently  of  the  other.  The  jaws,  like  other  members,  are 
influenced  by  the  independent  growth  of  the  two  halves,  so  that 
each  has  its  own  peculiarities.  Asymmetry,  therefore,  is  caused 
from  an  inharmonious  lateral  development  of  the  parts.  The 
superior  and  inferior  maxillary  bones,  growing  independently 
of  each  other,  may  be  subjected  to  peculiar  conditions  of  envi- 
ronment so  that  the  result  of  their  development  may  be  asym- 
metry of  the  jaws.  Extreme  asymmetry  of  the  lateral  halves  of 
the  human  body  is  frequently  observed. 


220 


IRREGULARITIES    OF    THE    TEETH. 


Exact  measurements  of  the  maxillary  bones  will  show  lack 
of  harmony  in  the  lateral  halves;  to  be,  observed  in  weight, 
shape  and  size.  The  difference  is  generally  not  sufficient  to 
affect  the  contour  of  the  face,  but  causes  faulty  articulation 
to  the  teeth  upon  that  side  of  the  face.  This  is  generally  due 
to  the  number  of  teeth  that  remain  in  the  jaw  late  in  life.  Thus 
a  molar  or  bicuspid  may  never  have  developed  upon  one  side, 
wdiile  the  full  number  are  in  position  upon  the  other  side,  or 
they  may  have  been  extracted  upon  one  side,  while  the  full  num- 
ber remain  upon  the  other.  Again,  owing  to  an  irregularity  of 
the  teeth  in  the  anterior  part  of  the  mouth  the  posterior  teeth, 


Via.  78. 


although  all  are  present,  may  have  moved  forward.  In  any 
of  these  conditions  the  alveolar  process  and  jaw  would  become 
shorter  upon  one  side  than  upon  the  other,  owing  to  absorption 
of  the  alveolar  process.  The  deformities  of  either  lateral  side 
of  the  superior  maxilla  are  not  necessarily  like  those  of  the 
inferior.  Excessive  growth  or  arrested  development  appear 
upon  both  sides  of  the  jaws,  sometimes  on  the  right  and  again 
upon  the  left.  Examinations  of  these  deformities  can  be  made 
only  when  the  second  teeth  have  been  extracted  and  the  alveolar 
process  has  been  absorbed. 

Fig.  yy  shows  the  superior  maxilla  after  absorption  has  taken 
place.    If  a  line  be  drawn  through  the  jaw  at  the  median  line,  it 


DEVELOl'MF.NTAL    NEUROSES    OF    THE    MAXILLARY    BONES,       221 

will  be  seen  that  the  left  half  is  fully  developed,  while  the  right 
half  is  contracted  at  the  bicuspid  region.  The  following  statistics 
show  the  deformities  in  the  contour  of  jaws  modeled  by  Ur.  L. 
P.  Haskell,  of  Chicago : 

UPPER   JAW. 

Total    muiiber   exaininod    298 

Total  number  normal  137 

Total  nimiber  abnormal,  right  side ']2) 

Total  number  abnormal,  left  side 88 

Fig.  y^  illustrates  the  inferior  maxilla  after  the  teeth  have 
been  extracted  and  absorption  of  the  alveolar  process  has  taken 
place.  By  drawing  a  Hne  through  the  center  of  the  lower  jaw 
at  the  median  line  a  wider  space  may  be  seen  to  exist  between 
the  line  and  the  left  side  than  on  the  other  side. 

LOWER  JAW. 

Total  number  examined   154 

Total  number  normal  54 

Total  number  abnormal,  right  side 12 

Total  number  abnormal,  left  side 88 


rig.  w). 

Although  no  two  cases  of  irregularities  of  the  teeth  are 
exactly  ahke,  there  is  a  general  similarity  of  shape  and  outline 
of  alveolar  process  and  jaw,  owing  to  similar  environments 
during  eruption  of  the  teeth.  Upon  the  hypothesis  that  the 
two  halves  of  the  superior  maxilla  are  developed  in  proportion 
to  the  excess  of  food  masticated  on  one  side  or  the  other,  depend- 
ing upon  right  and  left  handedness  of  the  individual,  it  seemed 
probable  the  case  illustrated  is  that  of  a  left-handed  person, 
as  the  left  side  of  the  jaw  is  larger.  But  it  appears  that  this 
side  is  normal  in  size  and  the  right  is  deficient  in  development. 
On  examining  carefully  the  contour  of  patient's  teeth  but  few 
arches  are  found  uniform.  While  one  side  may  be  normal  the 
other  will  be  depressed.     Fig.  79  shows  such  a  deformity.    This 


222  IRREGULARITIES    OF    THE    TEETH. 

cut  is  taken  from  a  model  of  an  extreme  case  of  irregularly- 
shaped  jaw.  It  represents  a  perfect  semi-V-shaped  arch.  (I 
find  in  my  collection  of  models  thirty-eight  of  this  variety  of 
deformity,  twenty-four  of  which  are  on  the  right  side  and  four- 
teen on  the  left.)  Most  of  these  irregularities  are  not  quite  as 
depressed  at  the  cus])id  region  as  the  cut  indicates.  No  two 
are  exactly  alike  as  regards  the  position  of  the  teeth  and  yet 
the  similarity  is  so  complete  that  a  non-professional  man  would 
immediately  take  notice  of  it.  The  asymmetry  of  the  jaw  illus- 
trated in  Fig.  77  is  probably  caused  by  the  peculiar  arrangement 
of  the  permanent  teeth  in  the  arch,  since  the  deformity  is  not 
apparent  during  the  first  set  of  teeth,  the  alveolar  process  and 
maxillary  bones  being  molded  into  this  peculiar  shape  thereby. 
Since  but  few  people  are  left-handed,  this  percentage  is  very 
large,  showing  twenty-four  out  of  thirty-eight  cases  with  defi- 
ciencies on  the  right  side,  when  we  might  look  for  normal  or 
excessive  development  on  that  side.  The  cause  of  this  irregular- 
ity is  of  local  origin,  viz.,  too  early  extraction  of  the  temporary 
teeth  upon  the  affected  side,  thus  showing  that  one  side  is  as 
liable  to  be  afifected  as  the  other.  The  mechanism  of  this  irregu- 
larity will  be  found  under  the  head  of  local  causes. 

The  asymmetry  upon  the  lower  jaw  may  be  traced  to  two 
causes : 

First :  The  full  number  of  teeth  retained  upon  the  long  side 
If  the  third  molars  should  develop  on  one  side  only,  the  jaws  on 
that  side  would  expand  by  the  crowded  condition  of  the  teeth 
and  extend  farther  from  the  median  line  than  otherwise.  The 
loss  of  the  third  molars  by  extraction  or  non-development  would 
prevent  the  other  side  from  increasing  to  the  natural  size. 

Second :  The  relation  of  the  upper  teeth  to  the  lower  teeth. 
The  articulation  of  the  inferior  maxilla  with  the  cranium  is  so 
remote  and  the  contour  of  the  two  bones  so  unlike,  that  uni- 
formity of  bone-structure  cannot  be  looked  for.  When  the  com- 
plexity of  the  development  of  bone-tissues,  first  of  the  maxillary 
bone,  then  of  the  alveolar  process  and  lastly  of  the  two  sets  of 
teeth,  is  remembered,  it  is  a  wonder  that  harmony  ever  pre- 
vails. 


DEVELOPMENTAI.    NEUROSES    OF    THE    MAXILLARY    BONES.      223 

Haskell's  deformity.^  On  examining  models  of  the  superior 
maxilla  after  absorption  of  the  alveolar  process  has  taken  place, 
it  is  observed  that  in  the  cuspid  and  bicuspid  region,  high  above 
the  alveolar  border,  a  marked  depression  exists  on  either  §ide. 
Fig.  80  shows  a  base  plate  which  has  been  formed  over  such  a 
model.  The  plate  is  more  depressed  at  the  left  than  at  the  right 
side.  This  peculiar  deformity  is  familiar  to  the  operator  who 
arranges  teeth  and  waxes  up  plates  for  the  purpose  of  restoring 
the  contour  of  the  face.  Upon  closer  inspection  of  the  model 
it  will  be  seen  that  there  is  asymmetry  of  the  lateral  halves  of 
the  maxillary  bones.  With  Haskell's  assistance,  I  examined 
298  models,  finding  268  out  of  the  number  with  marked  depres- 


Fig.  80. 

sion  on  the  left  side,  and  twenty-four  with  the  depression 
on  the  right  side.  Only  six  cases  on  both  sides  were  alike. 
This  depression  is  due  to  an  asymmetry  of  the  maxillary  bones. 
An  asymmetry  so  slight  as  to  be  hardly  recognizable  may  pro- 
duce it.  As  the  body  has  passed  from  left-handedness  to  right- 
handedness,  the  left  side  being  the  weaker  as  least  used  a  large 
proportion  of  cases  of  this  depression  are  necessarily  found  on 
the  left  side. 

For  many  years  Haskell  has  observed  a  marked. difference 
between  the  right  and  left  sides  of  models  of  both  the  upper 

"  I  have  named  this  deformity  "Haskell's  Deformity"  for  the  reason 
that  Dr.  Haskell  first  called  the  attention  of  the  profession  to  this  peculiar 
condition  of  the  maxillary  bones  years  ago. 


224  IRREGULARITIES    OF    THE    TEETH. 

and  lower  jaws,  but  more  especially  noticeable  in  the  upper  jaw. 
It  is  not  so  apparent  upon  a  casual  glance  at  the  model,  for  it 
is  not  so  much  in  the  alveolar  process  as  in  the  maxillarv  bones. 
But  .a  plate  swaged  upon  a  model  from  an  impression  taken 
high  over  the  region  of  the  cuspids  (as  ought  always  to  be  done) 
shows  at  once  the  depression  of  the  left  side,  which  occurs, 
to  a  greater  or  less  extent,  in  ninety-five  per  cent  of  cases.  The 
difference  becomes  apparent  in  arranging  artificial  teeth. 
Experienced  dentists  will  have  noted  that  greater  length  of  teeth 
and  gums  is  required  upon  the  left  side  than  upon  the  right. 
How  often  it  is  seen  that  the  left  side  of  the  lip  rises  higher  in 
talking  arjd  laughing  than  the  right  side.  The  difference  in  the 
two  sides  of  the  lower  jaw  does  not  occur  as  often,  but  fs 
apparent  in  the  divergence  of  the  left  side  from  a  line  drawn 
through  the  center  of  the  model  so  that  the  posterior  teeth  on 
that  side  must  be  set  farther  in  upon  the  plate. 

My  own  observation  of  models  and  patients  has  indicated  that 
the  majority  of  deformities  of  this  nature  exist  on  the  left  side. 
Man,  like  some  other  animals,  usually  moves  the  lower  jaw 
from  right  to  left  in  mastication.  (As  people  are  sometimes 
left-handed,  so  it  is  possible  to  find  cases  where  the  jaws  moved 
from  left  to  right).  The  constant  friction  of  the  lower  teeth 
against  the  upper,  and  the  crowding  of  the  teeth  into  place  while 
erupting,  carries  the  superior  arch  with  the  alveolar  process 
toward  the  right  or  left.  By  pressing  the  index  finger  over  the 
cuspid  and  bicuspid  roots,  above  the  alveolar  process  it  is  shown 
that  the  majority  of  mouths  contain  teeth  with  their  roots  stand- 
ing out  more  prominently  upon  the  right  side  than  upon  the  left 
side.  The  right  superior  dental  arch,  like  the  arch  of  a  bridge, 
resists  such  inward  force  because  of  the  lateral  contact  of  its 
teeth.  On  the  contrary,  the  left  superior  dental  arch  may  thus 
be  carried  slightly  forward.  The  limited  lateral  motion  during 
occlusion  prevents  the  teeth  and  alveolar  process  from  being 
carried  farther.  The  cuspid  tooth  may  be  prevented  from  being 
carried  in  as  far  as  it  otherwise  would  be  owing  to  the  lateral 
motion  of  the  lower  jaw  to  the  left.  The  alveolar  process  is  thus 
carried  beyond  the  border  of  the  maxillary  bones.  After  the 
teeth  have  been  removed,  absorption  of  the  alveolar  process 


DEVELOPMENTAL    NEUROSES    OF    THE    MAXILLARY    HONES.      225 

occurs,  leaving  only  the  alveolar  ridge.  The  ridge  then  over- 
hangs the  maxillary  bone,  thus  producing  a  depression  upon  the 
left  side.  This  is  the  reason  that  in  arranging  artificial  dentures 
in  many  cases  the  teeth  are  carried  over  the  alveolar  border 
farther  than  upon  the  right  side  to  obtain  proper  articulation 
with  the  natural  teeth  upon  the  lower  jaw. 

On  examining  the  model  upon  which  the  base-plate  was 
formed,  it  will  be  seen  that  both  the  right  and  left  alveolar  bor- 
ders are  symmetrical.  The  alveolar  border  in  most  cases  indi- 
cates the  contour  of  the  teeth  when  in  position. 

A  case  seen  with  G.  Frank  Lydston  is  a  marked  illustration 
of  congenital  maxillary  asymmetry.  The  man  is  thirty  years 
of  age.  The  inferior  maxillary  is  small  and  the  chin  pointed 
and  narrow.  There  is  a  difiference  of  one-half  an  inch  in  the 
length  of  the  rami,  the  left  ramus  being  the  shortest.  The 
difference  is  sufficient,  when  the  face  is  smoothly  shaven,  to 
produce  a  noticeable  deformity.  The  teeth  are  irregular  in  both 
jaws,  the  irregularity,  however,  being  most  marked  in  the 
superior  jaw.  The  cranium  partakes  of  the  asymmetry  and  the 
frontal  suture  is  plainly  marked.  Numerous  irregularities  of  the 
surface  of  the  skull  are  observable.  The  larynx  is  displaced  at 
least  one-half  an  inch  from  the  median  line  toward  the  left  side. 
There  is  no  history  of  injury  and  a  point  of  interest  in  this  case 
is  the  fact  that  the  asymmetrical  and  small  jaw  is  a  family  char- 
acteristic and  has  been  noticed  for  several  generations.  The 
jaw,  in  this  case,  resembles  the  father's,  while  the  arrangement 
of  the  teeth  is  similar  to  that  of  the  mother.  The  upper  portion 
of  the  body  appears  to  have  been  developed  in  two  lateral  halves 
and  when  brought  together  the  left  side  of  the  body  was  higher 
than  the  right  side.  The  cranium  and  maxillary  bones  show  this 
deformity  quite  conspicuously.  The  teeth,  which  are  compara- 
tively sound,  are  all  present.  The  left  superior  maxilla  is  con- 
siderably higher  than  the  right.  Occlusion  is  perfect,  thus 
compensating  for  the  short  left  ramus. 

Another  similar  case  is  that  of  a  twenty-year-old  woman, 
who  has  arrest  of  development  of  the  upper  jaw.  The  body 
of  the  lower  jaw  is  excessively  developed.  Length  of  right 
ramus,  2.25  inches;  left,  1.50  inches.    The  result  is  that  the  lower 

16 


226  IRREGULARITIES    OF    THE    TEETH. 

jaw  is  thrown  to  the  left  the  width  of  the  right  central  incisor 
tooth.    Her  father  and  uncle  have  a  similar  deformity. 

A  seventeen-year-old  girl  came  for  treatment  September 
14th,  1888.  She  had  quite  a  prominence  upon  the  right  side  of 
the  lower  jaw  and  another,  although  not  so  marked,  upon  the 
left  upper  jaw.  The  left  corner  of  the  mouth  was  nearly  one- 
quarter  of  an  inch  higher  than  the  right.  The  face  was  full 
and  had  a  peculiar  expression,  owing  to  the  mouth  and  jaw 
being  at  an  angle  when  closed.  Upon  examination,  the  left 
superior  maxilla  was  found  one-quarter  of  an  inch  higher  than 
the  right  side.  The  alveolar  process  and  teeth  shared  the  same 
irregularity,  thus  placing  the  line  of  the  teeth  on  the  same  plane 
as  the  lips.  The  body  of  the  inferior  maxilla,  from  the  symphy- 
sis to  the  angle,  seemed  to  be  longer  upon  the  left  side  than  upon 
the  right.  When  the  jaw  closed,  the  median  line  of  the  lower 
jaw  was  half  an  inch  to  the  right  of  the  upper.  The  lingual 
cusps  of  the  bicuspids  and  molars  on  the  right  side  of  the  lower 
jaw  occluded  with  the  buccal  cusps  of  the  bicuspids  and  molars 
of  the  upper  and  vice  versa  upon  the  left  side. 

Asymmetry  may  be  due  to  excessive  development  of  the 
body  of  the  jaw  on  one  side  and  arrest  of  development  on  the 
other. 

In  the  two  cases  described,  while  the  causes  and  the  external 
appearance  of  the  face  are  entirely  different,  the  alveolar  proc- 
esses and  the  occluding  surfaces  of  the  teeth  are  on  the  same 
angle,  the  inclination  being  in  the  same  direction.  This  deform- 
ity is  found  in  the  mouths  of  patients  over  forty  years  of  age, 
where  all  the  teeth  have  been  removed  upon  the  side  of  one  jaw 
and  upon  the  opposite  side  of  the  other,  the  alveolar  processes 
containing  the  teeth  elongating  upon  the  side  where  there  is 
no  antagonism  and  throwing  the  occluding  line  of  the  teeth  out 
of  position  at  an  angle  similar  to  that  above  described. 

On  examining  1,977  idiots  (Table  XIV)  there  were  found 
to  be  159  with  protrusion  of  the  superior  maxilla  and  92 
with  protrusion  of  the  inferior  maxilla.  These  deformities  do 
not  exist  to  such  an  extent  among  healthy  individuals.  This 
inharmonious  development  of  the  maxillary  bones  may  extend 
from  the  articulation  to  the  incisor  teeth.    Such  deformities  are 


DEVELOPMENTAL    NEUROSES    OF    THE    MAXILLARY    BONES. 


227 


rarely  found  in  connection  with  the  first  set  of  teeth.  When 
the  alveolar  process  protrudes  during  the  period  of  the  tem- 
porary teeth,  it  is  usually  caused  by  thumb-sucking  or  an  arrest 
of  development  of  the  inferior  maxilla.  Protrusion  of  the  inferior 
maxilla  is  the  result  of  the  abnormal  development  of  the  rami 
or  body  of  the  jaw  or  an  arrest  of  development  of  the  superior 
maxilla.  As  these  abnormal  conditions  usually  correct  them- 
selves when  the  temporary  teeth  are  shed,  they  consequently 
receive  little  attention.  But  when  these  deformities  arise  during 
second  dentition  the  jaws  are  determined  toward  false  positions, 
thus  endangering  the  beauty  of  the  face.    Occasionally  in  acro- 


Pior.  81. 


megaly  and  other  hypertrophic  states  occurs  excessive  growth  or 
there  is  physiologic  hypertrophy  of  the  superior  maxilla,  when 
the  inferior  maxilla  is  unusually  developed.  When  the  teeth 
are  normal  in  size  they  appear  small  in  proportion  to  the  abnor- 
mally large  jaw.  They  are  carried  forward  with  the  alveolar 
process  to  such  a  degree  that  the  teeth  and  lips  may  protrude. 
In  such  cases  it  appears  as  if  the  body  or  rami  of  the  inferior 
maxilla  were  much  shorter  than  is  natural,  but  by  close  inspec- 
tion we  shall  see  that  the  inferior  maxilla  is  normal  and  quite 
a  space  exists  between  the  superior  and  inferior  central  incisors. 
A  slight  protrusion  of  the  superior  teeth  is  a  common  defect 
and  is  usually  accompanied  by  depression  of  the  face  at  the  root 


228 


IRREGULARITIES    OF    THE    TEETH. 


and  alse  of  the  nose  and  protrusion  of  the  anterior  alveolar 
process  and  upper  lip.  If  the  maxillary  bones  as  well  as  the 
alveolar  process  be  enlarged,  the  teeth  will  stand  perpendicu- 
larly with  the  alveolar  process.  If  the  superior  maxillary  bones 
be  small,  the  teeth  will  ])rotrude  from  the  perpendicular  to  an 
angle  of  45  degrees.  Such  a  case  is  illustrated  in  Fig.  64,  page 
131  (Kingsley's  "Oral  Deformities").  This  is  a  deformity  fre- 
quently met  with  in  practice.  A  connnon  cause  of  protrusion 
of  the  superior  maxilla  is  illustrated  in  Fig.  81.  The  teeth  in  the 
upper  jaw  are  fully  erupted  but  are  directed  downward  and 
forward ;  the  teeth  in  the  lower  jaw  are  in  their  proper  ]iosition. 
Here  the  rami  of  the  jaw  are  inharmoniously  developed,  the 


Fig.  82. 

rami  being  so  short  when  the  jaws»  close  that  the  occlusion 
throws  the  superior  teeth  and  alveolar  process  forward.  In 
this  case  the  alveolar  process  is  quite  thin,  because  the  arch  is 
high  and  the  teeth,  having  long  slender  roots,  are  easily  carried 
forward.  The  inferior  maxilla  is  large,  the  structure  dense  and 
hard  and  the  teeth  firmly  fixed  in  position  in  the  jaw.  When 
occlusion  takes  place,  the  weaker  structure  (the  superior  maxilla) 
is  carried  forward  by  the  stronger  (the  lower  maxilla),  thus  forc- 
ing the  alveolar  process  forward^  producing  harmony  through- 
out the  articulation.  The  shortness  of  the  rami  of  the  inferior 
maxilla,  causing  improper  closing  of  the  jaws,  is  a  feature 
strongly  impressed  upon  the  dentist  who  undertakes  to  insert 


DEVEI.OrNrENTAT,    NEUROSES    OF    THE    MAXILLARY    BONES.       229 

artificial  dentures.  The  tendency  of  the  lower  jaw  to  force  an 
upper  denture  out  of  the  nioutli,  by  striking  the  teeth  at  an 
angle  instead  of  perpendicularly,  is  a  marked  illustration  of  the 
inharmonious  development  of  the  jaws.  The  same  difficulty  is 
frequently  experienced  with  the  partial  lower  plate  when  it 
presses  against  the  anterior  teeth  and  alveolus,  forcing  them 
both  forward  by  improper  articulation.  The  occasional  grinding 
of  the  surfaces  of  the  artificial  molars  to  produce  proper  articu- 
lation is  another  illustration  of  the  effects  of  this  inharmonious 
development. 

Fig.  82  illustrates  a  deformity  produced  by  the  before-men- 
tioned cause  with  very  different  results.  The  case  is  that  of  a 
fourteen-year-old  boy.  Before  the  eruption  of  the  second  molars 
the  articulation  was  perfect;  but  as  soon  as  the  second  molars 
occluded  the  jaws  were  forced  open.  The  rami  are  so  short 
that  when  the  second  molars  and  the  alveolar  processes  of  the 
superior  and  inferior  maxilla  come  together  a  space  exists 
between  the  central  incisors. 

Unlike  the  former  case,  the  superior  alveolar  process  is 
remarkably  well  developed  and  the  teeth  are  firmly  fixed  in  the 
jaw.  The  vault  of  the  mouth  is  quite  low.  The  position  of  the 
teeth  in  the  alveolar  process  is  such  that  when  the  lower  teeth 
occlude  they  strike  directly  on  a  line  with  the  long  axis  of  the 
roots,  thus  preventing  the  forward  movement  of  the  teeth  and 
alveolar  process.  The  inferior  maxilla  is  not  well  developed, 
nor  has  it  the  power  to  overcome  the  resistance  and  force  the 
superior  alveolar  process  and  teeth  forward,  as  exemplified  in 
Fig.  81.  When  the  rami  are  so  short  that  they  do  not  harmonize 
with  the  maxillary  bones  the  movement  of  the  jaws  may  be  lik- 
ened to  the  arms  of  shears ;  the  farther  the  points  are  from  the 
center,  the  greater  the  distance  they  have  to  travel.  A  slight 
movement  at  the  center  will  cause  them  to  move  a  considerable 
distance.  In  a  similar  manner  a  slight  excessive  protrusion  of 
a  molar  will  cause  the  anterior  teeth  to  become  separated.  The 
shorter  the  rami,  the  less  the  harmony  between  the  jaws  and 
teeth ;  the  farther  back  the  protruding  molar  and  the  more  it 
projects,  the  greater  the  anterior  separation  of  the  jaws.  The 
excessive  eruption  of  the  second  and  third  molars  is  very  often 


230 


IRREGULARITIES    OF    THE    TEETH. 


due  to  the  persons  sleeping  with  the  mouth  open;  the  pressure 
upon  the  posterior  teeth  being  removed,  the  teeth  and  even  the 
alveolar  process  will  elongate.  Not  infrequently  the  mal-occlu- 
sion  of  the  teeth  is  due  to  the  inability  to  close  the  jaws  on 
account  of  the  inharmonious  development.  Occasionally  there 
are  mouths  in  which  the  molars  and  bicuspids  occlude  and  there 
is  just  enough  space  between  the  centrals  to  admit  a  thin  spatula. 
January,  1887,  a  patient  was  brought  for  advice  whose  jaws  when 
closed  showed  a  space  of  half  an  inch  between  the  incisors.  Such 
cases  are  due  to  arrest  of  development  of  the  anterior  alveolar 
process,  the  superior  dental  arch  being  too  small  for  the  inferior. 
The  pressure  of  the  jaws  upon  the   molar  teeth  is,  in  some 


'■     Fig.  83. 

instances,  so  great  that  normal  eruption  is  impossible.  In  such 
cases  the  molars  will  protrude  through  the  gum  and  the  superior 
and  inferior  processes  will  occlude  when  the  jaws  meet. 

Protrusion  of  the  inferior  maxilla,  since  it  produces  a  most 
repulsive  deformity  of  the  face,  should  be  corrected  as  early  in 
life  as  possible.  When  caused  by  or  associated  with  arrested 
development  of  the  superior  maxilla,  it  is  extremely  difficult  to 
restore  the  features  to  a  natural  expression.  A  case  (Fig.  83) 
came  to  my  notice  in  1887,  of  a  commercial  traveler  from  New 
York,  who  called  for  the  purpose  of  having  a  gold  crown  reset. 
There  was  marked  deformity  in  the  jaws,  consisting  of  a  depres- 


DEVELOPMENTAL    NEUROSES    OF    THE    MAXILLARY     HONES.        231 


sion  at  the  alae  of  the  nose  and  an  unusual  protrusion  of  the 
inferior  maxilla.  Upon  examination,  the  second  molar  on  the 
upper  jaw  and  the  third  molar  on  the  lower  jaw  were  found  to 
be  the  only  teeth  that  occluded.  This  was  caused  by  arrest  of 
development  of  the  bones  of  the  face  and  an  excessive  length 
of  the  rami  of  the  lower  jaw.  The  body  was  normally  devel- 
oped, but  was  carried  forward  by  a  lengthening  of  the  rami.  To 
add  to  this  deformity,  there  was  marked  arrest  of  development 
of  the  bones  of  the  face.  There  are  cases  where  the  lower  jaw 
projects  beyond  the  upper ;  but  on  closely  examining  the  deform- 
ity another  cause  is  found  for  this  appearance. 


Fig.  84. 

A  girl  fifteen  years  of  age  was  sent  for  treatment  by  a  dentist 
from  a  neighboring  state.  He  desired  me  to  "force  the  inferior 
maxilla  back  into  place."  The  rami  and  body  of  the  jaw  were 
apparently  normal.  The  external  appearance  of  the  chin  and 
cheeks  was  in  keeping  with  the  outline  of  the  face.  The  upper 
lip  was  much  depressed  and  deep  lines  extended  from  the 
alse  of  the  nose  to  the  corner  of  the  mouth.  The  cheek  bones 
were  also  undeveloped.  Upon  opening  the  mouth,  arrest  of 
development  of  the  superior  maxilla  was  found.  The  superior 
incisors  closed  inside  of  the  inferior  incisors ;  the  first  and  second 
bicuspids,  first  and  second  molars,  were  in  position,  but  had 
crowded  forward  close  to  the  lateral  incisors.  The  cuspids  were 
quite  outside  the  arch.    The  superior  dental  arch  had  to  be  forced 


232 


IRREGULARITIES    OF    THE    TEETH. 


out,  instead  of  carrying-  the  inferior  maxilla  in,   which  would 
tend  to  further  complicate  the  case. 

In  the  case  of  a  young  man  was  found  what  had  been  regarded 
as  a  "prognathous  lower  maxilla."  This  was  caused  by  arrested 
development  of  the  upper  maxilla.  Five  years  had  already 
been  spent  in  trying  to  reduce  the  deformity.  Had  the  attempt 
succeeded  the  deformity  would  have  been  greater  than  it  was. 
Instead  of  moving  the  lower  teeth  back  the  upper  teeth  should 
have  been  moved  forward.  After  six  months'  treatment  on 
this  plan  the  teeth  were  corrected  and  the  face  greatly  improved. 


Fig.  85. 


In  the  majority  of  cases  which  appear  tc  result  from  a  pro- 
trusion of  the  lower  jaw,  the  lower  maxilla  does  not  project 
abnormally  but  the  superior  maxilla  being  arrested  in  its  devel- 
opment, gives  the  protruding  appearance  to  the  lower  jaw. 
Before  undertaking  to  correct  such  a  deformity  the  general  con- 
tour of  the  face  should  be  carefully  studied. 

A  peculiar  and  common  •  deformity  of  the  inferior  maxilla 
(Fig.  84)  is  that  where  the  body  of  the  jaw  is  very  short.  A 
line  dropped  perpendicularly  and  touching  the  chin  at  the  median 
line  would  pass  through  the  bicuspid  region  of  the  superior 
maxilla.     A  front  view  of  such  a  deformity  has  an  appearance 


DEVELOPMENTAI,    NEUROSES    OF    THE     MAXILLARY     BONES.       233 


as  though  the  lower  jaw  were  absent  and  a  side  view  throws 
the  nose  out  prominently  while  the  chin  and  forehead  retreat. 
The  rami  of  the  jaw  are  larger  than  the  body.  The  articulation 
is  good,  the  defect  being  that  the  teeth  in  the  incisor  region 
strike  quite  a  distance  posterior  to  the  superior  incisors.  Arrest 
of  development  of  the  lower  jaw  frequently  result  when  the 
superior  incisors  are  crowded  inward  irregularly,  or  when  there 
is  arrest  of  development  of  the  superior  maxilla,  the  lower  incis- 
ors coming  in  contact  with  them,  thus  preventing  the  forward 
development  of  the  body  of  the  jaw.  The  anterior  portion  of 
the  lower  jaw  remains  stationary,  while  the  development  is  in 
the  posterior  direction. 


Fig.  86. 

Fig.  85  represents  jaws  such  as  are  frequently  seen.  The 
long  body  and  protruding  chin,  narrow  and  contracted  alveolar 
process  on  the  lower  jaw,  a  small  superior  maxilla  and  thin 
protruding  alveolar  process  are  in  keeping  with  the  thin  faces 
and  sharp  features  of  the  class.  The  body  of  the  inferior  maxilla 
is  small,  thin  and  very  delicate ;  the  rami  unusually  short — just 
opposite  to  the  one  last  described.  A  line  drawn  parallel  with 
the  occluding  surfaces  of  the  teeth  would  meet  the  angle  of  the 
jaw,  which  in  a  normal  jaw  would  extend  from  one  to  one  and 
a  half  inches  below  the  line.  Naturally  slender,  delicate  muscles 
and  tendons  are  associated  with  such  bones.  In  these  cases 
dislocation  of  the  inferior  maxilla  is  liable  to  occur  while  yawn- 
ing or  during  dental  operations,  so  great  is  the  leverage.  In 
this  instance  the  length  of  the  jaw  compensated  for  the  width. 


234 


IRREGULARITIES    OF    THE    TEETH. 


SO  that  in  this  particular  case  the  teeth  are  not  irregular; 
although  irregularity  frequently  accompanies  this  peculiar  for- 
mation of  the  jaw.  This  is  particularly  the  case  with  the  saddle 
or  V-shaped  arches  on  the  upper  jaw  and  the  saddle-shaped 
and  forward  inclination  of  the  molars,  bicuspids  and  cuspid  teeth 
on  the  lower  jaw.  The  roof  of  the  mouth  is  also  very  high  and 
the  alveolar  process  very  thin,  giving  the  roots  of  the  teeth  but 
slight  support.  The  same  principle  of  organization  and  structure 
is  operative  in  the  alveolar  process  and  teeth  of  the  lower  jaw. 
Fig.  86  represents  the  jaws  of  a  patient,  twenty-six  years 
of  age,  in  whom,  on  examination,  was  found  a  small  normal 
inferior  maxilla,  well  protruded  and  in  harmony  with  the  other 


Fig.  87. 

features  of  the  face.  The  superior  maxilla  and  alveolar  process 
were  excessively  developed,  the  first  molar  and  anterior  teeth 
describing  a  much  larger  circle  than  the  lower.  The  second 
molars  were  the  only  teeth  that  articulated  properly.  The 
anterior  alveolar  process  had  taken  on  a  profile  deposition  of 
bone-cells  until  the  teeth  impinged  upon  the  gum  of  the  lower 
jaw,  producing  absorption  and  expansion.  The  upper  lip  was 
covered  with  a  mustache  which  completely  hid  the  deformity. 
Under  such  conditions  a  prominence  is  observed  at  the  alae  of 
the  nose — the  upper  lip  being  drawn  over  the  alveolar  process. 

Fig.  87  represents  a  case  rarely  met  with.  The  body  of  the 
inferior  maxilla  is  excessively  developed,  the  extent  of  the  irreg- 
ularity depending  on  the  degree  of  development.    When  only  a 


DEVELOPMENTAL    NEUROSES    OF    THE    MAXILLARY    BONES.      235 

slight  protrusion  exists  the  incisors  strike  beyond  the  superior 
incisors.  In  extreme  cases  only  the  molars  articulate.  When 
the  anterior  teeth  articulate  the  alveolar  process  develops  so 
that  the  teeth  extend  to  the  superior  alveolar  process.  The 
features  may  be  otherwise  quite  regular.  Asymmetry  of  the  jaws 
often  continues  to  develop  until  the  osseous  system  has  obtained 
its  growth. 

Complete  absence  of  the  inferior  maxilla,  as  Gould  remarks, 
is  much  rarer  in  man  than  in  animals.  Nicolas  asd  Prenant 
have  described  a  case  of  this  in  a  sheep.  Gurlt  has  observed 
cases  with  total  or  partial  absence  of  the  inferior  maxilla, 
agnathes  or  hemignathes.  Simple  atrophy  of  the  inferior  maxilla 
occurs  in  man  and  the  lower  animals,  but  is  much  less  frequent 
than  atrophy  of  the  superior  maxilla.  Langnebeck  reports  the 
case  of  a  young  man  who  had  the  inferior  maxilla  so  atrophied 
that  in  infancy  it  was  impossible  for  him  to  take  the  breast. 
The  patient  had  nearly  complete  immobility  of  the  jaws.  Boul- 
lard  reports  a  facial  deformity  with  deficiency  of  the  condyles 
of  the  lower  jaw.  Maurice  has  reported  a  vice  of  conformation 
of  the  lower  jaw  which  rendered  lactation  impossible.  Tomes 
describes  a  lower  jaw,  the  development  of  the  left  ramus  of 
which  had  been  arrested.  Canton  describes  an  arrest  of  devel- 
opment of  the  left  perpendicular  ramus  of  the  lower  jaw  com- 
bined with  external  malformation.  The  bull  dog  seemingly 
displays  inferior  maxillary  prognathism,  but  here  the  deformity 
is  really  superior  brachygnathism,  as  he,  E.  C.  Kirk  and  others 
have  shown,  the  superior  maxilla  being  arrested  in  development. 
As  the  bull  dog  here  illustrates  a  degeneracy  likewise  occurring  in 
man,  its  value  as  an  understudy  in  jaw  and  tooth  irregularity 
is  obvious. 


CHAPTER  XXHI. 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT. 

Many  years  ago  Langdon  Down,  in  a  paper  read  before  the 
British  Odontologic  Society,  stated  with  regard  to  the  idiots  in 
the  Earlswood  Asyhim  that :  "Of  the  most  significant  value, 
however,  is  the  condition  of  the  palate.  I  have  made  a  very  large 
number  of  careful  measurements  of  the  mouths  of  the  con- 
genitally  feeble-minded  and  of  intelligent  persons  of  the  same 
age,  with  the  result  of  indicating,  with  some  few  exceptions, 
a  markedly  diminished  width  between  the  posterior  bicuspids 
of  the  two  sides.  One  result,  or  rather  one  accompaniment, 
of  this  narrowing  is  the  inordinate  vaulting  of  the  palate.  The 
palate  assumes  a  roof-like  form.  The  vaulting  is  not  simply 
apparent  from  the  approximation  of  the  two  sides ; it  is  absolute — 
the  line  of  juncture  between  the  palatal  bone  occupying  a  higher 
plane.  Often  there  is  an  antero-posterior  sulcus  corresponding 
to  the  line  of  approximation  of  the  two  bones.  An  appeal  to 
the  condition  of  the  mouth  is  an  important  aid  in  determining 
whether  the  lesion  on  which  the  mental  weakness  depends  is 
of  intra-uterine  or  post-uterine  origin.  In  the  event  of  the 
mouth  being  abnormal  it  indicates  a  congenital  origin;  while  if 
the  mouth  is  well  formed  and  the  teeth  are  in  a  healthy  condi- 
tion, it  would  lead  to  the  opinion  that  the  calamity  had  occurred 
subsequently  to  embryonic  life." 

These  conditions,  when  present  in  children,  were  patho- 
gnomic of  idiocy,  according  to  Langdon  Down.  Further  inves- 
tigation showed  while  many  idiots  and  imbeciles  possessed  low, 
narrow  vaults,  many  sane  people  had  high  vaults  and  V  and 
saddle-shaped  arches.  Clay  Shaw^  decided  from  the  results  of' 
his  researches  that  while  there  is  no  necessary  connection 
between  a  high  palate  and  a  degree  of  mental  capacity  of  the 
individual  a  high  palate  is  invariably  associated  with  narrow 
pterygoid  width  and  a  narrow  skull.  On  examination  of  Clay 
Shaw's  results  it '  is  evident  that  the  intellectual   standard  he 

^Journal  of  Mental  Science,  July,  1876. 

236 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT.        237 

adopted  was  too  limited  to  admit  of  his  sweeping  assertions  in 
regard  to  mental  capacity.  Furthermore  that  the  claim  anent 
narrow  skull  and  high  palate  is  a  sweeping  assumption  based 
on  a  few  selected  cases.  Examination  of  the  skulls  in  any 
moderately  sized  anthropologic  collection  will  disprove  this 
assertion.  Cuylitz,-  of  Belgium,  accepting  the  claim  of  the  con- 
nection of  high  vaulted  palates  with  mental  deficiency,  asserted 
in  explanation  that  "the  brain  tends  to  develop  transversely, 
but  it  meets  in  some  cases  a  resistance  in  the  parietal  region 
which  crowds  it  back.  This  pressure  is  transmitted  by  the  zygo- 
matic temporal  and  malar  processes  pushing  together  the  alve- 
olar borders  of  the  superior  maxillary  like  a  workman's  tongs 
(the  approximation  of  the  main  branches  of  which  is  that  of  the 
parietals)  brings  the  ends  together;  the  hinge  being  represented 
by  the  body  of  the  sphenoid  and  the  occipital.  This  bringing 
together,  therefore,  of  the  alveolar  borders  or  the  original  palate 
is  only  the  expression  of  a  cerebral  collapse  or  abnormal  effort 
which  in  the  psychic  life  reveals  itself  by  degeneracy." 

While  this  explanation  is  exceedingly  ingenious,  it  is  as  yet 
in  the  earliest  stages  of  a  working  hypothesis.  Idiocy,  it  should 
be  remembered,  is  but  a  bud  on  the  tree  of  degeneracy  and 
many  conditions  of  checked  development  found  in  it  are  found 
in  other  forms  of  degeneracy  as  well. 

It  is  not  surprising  that  practices  among  idiots  should  have 
been  charged  with  producing  palatal  deformities  really  due  to 
checked  development.  Ever  since  Imrie's^  time,  the  opinion  the 
"rabbit  mouth  is  due  to  keeping  the  thumb  in  the  mouth  for 
hours  after  going  to  sleep"  has,  with  various  modifications,  but 
without  careful  analysis,  been  repeatedly  reiterated  in  parrot-hke 
fashion.  The  first  attempt  to  corroborate  Imrie  was  that  of 
Thomas  Ballard,  who,  in  a  paper  on  the  "Constitutional  Ill- 
effects  of  Fruitless  Sucking  and  the  Diagnostic  Value  of  De- 
formed Jaws  in  Relation  Thereto,"  read  before  the  British  Odon- 
tological  Society  in  1864,  claimed  that  "as  in  idiots  are  seen  the 
worst  forms  of  defective  growth,  so  also  do  they  exhibit  the  most 
aggravated  forms  of  deformed  jaws  and  teeth  ;  the  habit  of  suck- 
ing being  retained  by  them  to  an  advanced  age." 

2  Annales  M^dico-Psychologiques,  XVII,  1885. 
8  Op.  Cit 


238  IRREGULARITIES    OF    THE    TEETH. 

When  the  size  of  the  vault,  especially  its  antero-posterior 
diameter,  is  compared  with  the  thumb,  lip,  tongue,  sugar  teat, 
etc.,  it  seems  absurd  to  suppose  for  a  moment  there  was  any 
comparison  in  size  between  the  two  or  that  depression  made  by 
any  of  these  could  produce  uniform  width  and  height  through- 
out the  entire  length  of  the  vault. 

Children  commence  to  suck  their  fingers  soon  after  birth. 
As  absorption  and  deposition  of  bone  cells  take  place  faster  at 
this  time  than  at  any  other  in  the  life  of  the  individual,  one 
would  naturally  expect  to  find  high,  narrow,  deformed  vaults  in 
connection  with  the  first  set  of  teeth  or  before  the  sixth  year, 
but  such  is  not  the  case.  Children  with  the  habit  of  finger  suck- 
ing often  have  very  low  vaults. 

Clouston,*  a  decade  ago,  attempted  study  of  the  palatal  stig- 
mata of  degeneracy  from  a  very  limited  standpoint.  As  he 
completely  ignored  all  previous  results  his  conclusions,  while 
not  undeserving  of  attention,  require  critical  analysis.  He  divides 
vaults  into  three  groups :  Typical  (or  Normal),  Neurotic  and 
Deformed.  The  first  has  a  low  but  regular  wide  dome  (Fig.  88, 
No.  i).  The  second  type  (Fig.  88,  No.  2)  is  designated  as  "neu- 
rotic" because,  according  to  Clouston,  the  "deformity  of  the 
palate  occurs  during  the  brain  growth,  early  in  the  life,  prob- 
ably in  utero."  In  Clouston's  opinion  this  indicates  "bad  initial 
neurotic  heredity."  The  third  type  (Fig.  88,  No.  3)  is  designated 
as  "deformed." 

The  conclusions  of  Clouston,  however,  need  not  be  discussed 
at  length,  since  they  are  largely  based  on  preconceived  notions 
which  ignore  the  researches  of  comparative  anatomists,  of  alien- 
ists of  world-wide  fame,  of  embryologists,  of  ethnologists  and 
of  criminal  anthropologists.  They  are  quoted  here  in  illustra- 
tion of  the  confused  contributions  on  this  subject.  In  a  general 
way,  Clouston  adopts  the  theory  of  Langdon  Down  in  1871 
and  Cole  in  1881,  that  "excessive  vaulting  of  the  palate  is  due 
to  arrest  of  development  of  the  sphenoid  bone"  and  "premature 
ossification  of  the  suture  at  the  base  of  the  skull."  In  consid- 
ering the  palate  and  upper  maxillary  bone,  one  must  take  into 
account,  Clouston  remarks,  the  following  considerations,  viz. : 

*  Journal  of  Mental  Science,  1890. 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  239 


Cloustoni  C(a55ificcirfon 


Neurofic 


Deformed. 


Fig.  88. 


240  IRREGULARITIES    OF    THE    TEETH. 

Its  relations  to  the  base  of  the  skull  in  man.  This  relation  is 
seen  to  be  close  and  absolute  as  compared  with  the  lower  ani- 
mals. If  a  perpendicular  line  is  drawn,  marking  the  most 
anterior  point  of  the  brain,  it  is  seen  to  fall,  in  man,  through  the 
center  of  the  hard  palate,  while  in  the  monkey  it  only  just 
touches  its  posterior  margin.  In  man  it  thus  has  a  direct  rela- 
tionship to  the  brain  base  and  its  shape  would  be  dominated  by 
the  width  of  this;  while  in  the  monkey  it  is  nearly  a  part  of  the 
alimentary  system,  having  little  relationship  to  the  base  of  the 
brain  at  all.  No  one  can  compare  the  two  without  seeing  that  its 
conformation  in  man  will  naturally  follow  any  changes  that  take 
place  during  development  in  the  skull-base.  If  the  skull,  in  its 
growth,  size,  shape,  dome  and  base,  is  absolutely  dominated  by 
the  brain  it  contains  and  on  which  it  depends,  then  the  brain- 
growth  will,  in  this  way,  secondarily  determine  the  shape  of  the 
upper  maxillary  bone  and  palate." 

If  the  intervening  space  between  the  base  of  the  brain  and 
the  vault  were  solid,  a  change  in  the  shape  of  one  might  exert 
influence  upon  the  other.  The  space  occupied  by  the  nares 
being  located  between  the  two,  with  two  strong  pillars  of  the 
superior  maxillary  bone  upon  either  side,  as  a  resistance  pre- 
cludes such  a  theory.  The  fact  that  the  jaw  has  become  less 
normal,  or  that  the  anterior  lobes  of  the  brain  have  developed 
and  become  more  prominent,  would  tend  to  the  belief  the  roof 
of  the  mouth  should  be  less  vaulted,  or  in  other  words,  the 
base  of  the  skull,  which  is  situated  above  the  vault  instead  of 
posterior  to  it,  would  occupy  much  of  the  space  necessary  for 
the  anterior  and  posterior  nares,  thus  crowding  down  the  vault. 
That  any  force,  produced  by  the  development  of  the  bones  at  the 
base  of  the  skull,  or  early  or  retarded  ossification  of  suture  in 
that  locality,  could  exert  any  influence  through  the  vomer  is  not 
well  taken. 

The  fact  that  the  vomer  does  not  ossify  until  puberty, the  thin- 
ness of  the  bone  after  ossification  has  taken  place,  and  that  it 
is  most  always  crimped  or  deflected  in  one  direction  or  another, 
is  evidence  that  no  effect  could  be  produced  upon  a  vault  of 
bone  supported  by  the  anterior  alveolar  process  and  with  a  rib 
or  suture  extending  its  entire  length,  which  ossified  years  before 


DEVELOl'MENTAL    NEUROSES    OF    THE    VAULT.  241 

any  changes  in  the  vault  were  noticed.  The  ridge  and  the  two 
vaults,  one  on  either  side,  often  extend  anteriorly  through  the 
alveolar  process  nearly  or  cjuite  to  the  incisor  teeth.  No  one 
would  claim  for  a  moment  that  the  vomer  could  exert  any  influ- 
ence upon  the  palate  either  up  or  down  through  the  maxillary 
bone  and  alveolar  process.  If  the  argument  were  true,  the  vomer 
before  it  could  draw  up  the  vault  would  necessarily  have  to  be 
drawn  taut,  but  such  a  condition  is  rarely  seen,  although  high 
vaults  be  numerous. 

According  to  Clouston,  "Those  palates,  where  the  deformity 
consists  in  a  ridge  down  the  center  antero-posteriorly,  seem  to 
show  that  in  them  the  deformity  took  place  at  a  later  period 
than  in  other  deformed  palates  where  the  nasal  septum  was 
getting  stronger  and  kept  the  center  of  the  palate  down,  while 
on  each  side  of  it  the  palate  was  drawn  up,  making  two  vaults, 
side  by  side,  instead  of  one." 

This  is  based  on  an  erroneous  theory.  This  deformity  in 
the  center  of  the  vault  may  be  present  as  early  as  the  second 
year,  or  at  the  time  'of  ossification.  If  the  theory  were  correct, 
that  contraction  at  the  base  of  the  skull,  producing  pressure 
through  the  vomer,  causes  the  high  vault,  when  vomer  ossifica- 
tion stops  this,  what  carries  up  the  sides  of  the  vault?  In  such 
case  the  vomer  would  be  perfectly  straight,  which  is  not  the 
fact. 

Clouston  reiterates  the  claim  many  times,  that  "the  deformity 
of  the  palate  (which,  of  course,  must  include  the  jaw)  occurs 
during  brain-growth,  early  in  life,  probably  in  utero."  This  is 
not  a  well  based  hypothesis,  since  the  brain  continues  to  grow 
until  the  seventh  or  eighth  year.  Moreover,  the  vault  does  not 
change  very  much  in  height  till  after  the  sixth  or  eighth  year; 
hence  a  high  vault  cannot  be  said  to  develop  early  in  Hfe,  much 
less  in  utero. 

Adopting  the  old,  pretty  generally  exploded  medical  notion 
of  the  pathologic  and  physiologic  importance  of  temperaments, 
Dr.  Robert  S.  Ivy'*  views  "dental  and  facial  types  as  part  of  the 
morphology  of  the  temperaments." 

"The  shape  of  the  alveolar  arch  and  the  dome  of  roof  of  the 

^  American  System  of  Dentistry. 
17 


242  IRREGULARITIES    OF    THE    TEETH. 

mouth,  also  the  articulation  of  the  teeth,  and  the  manner  in  which 
the  gum  is  festooned  over  each  tooth,  are  all  indicative  of 
the  several  temperaments  and  present  varieties  worth  attention. 
(Fig.  89.) 

The  arch  of  the  bilious  temperament,  from  cuspid  to  cuspid, 
is  almost  flat,  the  lines  backward  from  these  points  slightly 
diverging  in  an  almost  straight  line.  The  dome  of  the  mouth 
is  high  and  almost  square.  When  articulated,  the  upper  central 
incisors  overlap  the  lower  and  are  closely  locked.  In  general 
form  the  teeth  are  large,  the  corners  tending  to  squareness  and 
are  rather  long  in  proportion  to  their  breadth  ;  in  texture  they  are 
dense  and  strong.  The  proximal  surfaces  are  in  close  contact 
two-thirds  of  the  distance  from  the  cutting  edge  to  the  neck,  ren- 
dering the  festoon  of  the  gum  short  and  heavy. 

The  sanguine  arch  resembles  a  horseshoe  in  shape.  The 
dome  of  the  mouth  is  high  and  semi-circular.  The  articulation 
of  the  teeth  is  close  and  firm  and  their  structure  is  dense.  The 
masticating  surfaces  of  the  teeth  in  this  class  frequently  bite 
edge  to  edge  and  as  age  advances  they  are  gradually  worn  down 
to  the  gum  unless  protected  by  artificial  means.  In  general 
form  they  are  well  proportioned,  length  predominating  in  less 
degree  over  breadth,  and  their  outlines  are  rounded  and  curved. 
The  distal  and  mesial  surfaces  are  in  contact  a  little  more  than 
half  the  distance  from  the  cutting  edge  and  the  festoon  is  long 
and  delicate  in  outline. 

The  arch  of  the  nervous  temperament  presents  a  strong 
contrast  to  either  of  the  two  preceding  and  is  sometimes  spoken 
of  as  Gothic  from  its  pointed  character.  From  the  central 
incisors,  w'hich  often  overlap  for  want  of  space,  the  line  of 
remaining  teeth  continues  backward  with  a  slight  curve,  the 
greatest  prominence  being  between  the  cuspid  and  the  first  bicus- 
pid. The  roof  of  the  mouth  partakes  of  the  same  curve  and 
angles  as  the  arch.  The  articulation  of  the  teeth  is  not  close, 
but  long,  and  the  teeth  belonging  to  this  temperament  are  of 
average  density  and  structure.  In  shape,  length  predominates 
over  breadth ;  the  distal  corner  of  the  centrals  is  rounded,  giving 
the  whole  tooth  almost  the  appearance  of  a  lateral  and  the  cusps 
and  cutting  edges  are  long  and  fine.     The  point  of  contact  of 


DKVEI.OPMENTAI,    NEUROSES    OF    THE    VAULT.  243 


Ivy5  dqs^iftcqtion. 
Bilious. 


Sanguinary: 


Lymf-ihal'ic 


Fig.  89. 


Sanguinary   should  be   sanguine. 


244  IRREGULARITIES    OF    THE    TEETH, 

the  proximal  surfaces  is  near  the  cutting  edge,  giving  a  long, 
delicate  festoon  to  the  gum. 

The  lymphatic  arch  is  almost  semi-circular  in  its  outline  and 
somewhat  resembles  that  of  the  sanguine  temperament.  The 
dome  or  roof  of  the  mouth  is  flat  and  low.  The  articulation 
is  irregular  and  the  front  teeth  are  apt  to  protrude.  In  shape, 
breadth  predominates  over  length  and  the  normal  depressions 
and  elevations  are  either  entirely  absent  or  undefined.  The  fes- 
toon of  the  gum  is  thick  and  indefinite  in  outline.  The  lateral 
on  either  or  both  sides  is  frequently  out  of  line." 

The  temperament,  even  accepting  the  older  notions,  has 
nothing  to  do  even  with  the  shape,  size  and  character  of  the 
jaws  and  teeth.  The  vault,  above  all,  cannot  be  viewed  from 
such  standpoints. 

In  mouths  of  the  bilious,  sanguine,  nervous  or  lymphatic 
forms  of  temperaments  dental  arches  in  each  temperament  may 
measure  2.50  across  from  the  inner  surface  of  one  second  bicus- 
pid to  the  inner  surface  of  the  other.  The  dental  arch  may  range 
do^^■n  to  .96  in  width  and  the  antero-posterior  diameter  from 
1.86  to  2.43.  The  vaults  must  necessarily  range  in  height  and 
shape  to  correspond  to  the  width  and  length  of  the  dental  arch. 

From  hereditary  standpoints  temperament  should  not  have 
much  to  do  with  the  shape  of  the  dental  arch.  Two  individuals, 
one  of  nervous,  the  other  of  lymphatic,  bilious  or  sanguine  tem- 
perament, are  married;  the  offspring  inherits  the  jaws  of  one, 
the  teeth  of  the  other  and  the  temperament  of  the  child  is 
changed.  The  local  condition  is  such  that  shape  of  the  jaw  may 
change  type  of  the  vault.  One  child  may  possess  a  broad  dental 
arch,  but  very  short,  another  a  very  narrow,  long  dental  arch. 
Hence,  classification  of  the  dental  arch  and  vault  by  tempera- 
ment is  out  of  the  question. 

In  order  to  test  this  question,  however,  I  made  a  number 
of  examinations  along  the  lines  indicated  by  Ivy,  and  with  the 
assistance  of  a  medical  consultant,  as  to  these  temperaments. 
Under  brachycephalic,  mesocephalic  and  dolichocephalic,  sixty 
illustrations  (Plates  13  to  22)  were  made  and  classified  from 
models  of  white  individuals.  The  height  of  vault  varies  from 
.31  to  .81,  with  a  width  from   i  to  1.86;  the  antero-posterior 


DKVKI.OPMKNTAI.     NKUROSES    OK    THE    VAULT.  245 

ranges  from  1.87  to  2.50.  The  illiistrations  in  outline  are  as  dif- 
ferent as  it  is  possible  to  make  them  and  not  produce  a  deform- 
ity. Tims  in  the  anlcro-posterior  direction  (Figs,  j  and  7,  plates 
13  and  15)  a  brachycephalic  with  only  a  difference  of  .03  in 
width  of  head,  has  its  highest  part  in  the  vault  about  the  second 
molar,  while  another  (Fig.  6,  plate  13)  has  its  highest  at  the 
first  and  second  bicuspids.  A  mesocephalic  (Fig.  6,  plate  17) 
has  its  highest  part  midway  between  the  highest  part  of  (Figs. 
6  and  7)  the  brachycephalic. 

Viewed  from  the  lateral  outline,  some  brachycephales  (Figs. 
1 .  2  and  6,  plate  14)  are  seen  to  be  pinched  or  contracted,  and  this 
contraction  is  not  uniform  upon  both  sides.  Other  brachy- 
cephales (Figs.  3  and  7,  plates  14  and  16)  and  mesoceophales  (Fig. 
6,  plate  18)  are  broad.  Some  cases  (Figs.  3  and  7)  are  not  uniform 
upon  both  sides,  while  the  teeth  do  not  stand  in  the  same  direc- 
tion ;  some  vertical,  others  at  an  angle  of  45  degrees. 

Brachycephales  (Figs.  11  and  12,  plate  16),  mesocephales 
(Figs.  I,  3  and  4,  plate  18)  and  dolichocephales  (Figs.  4  and  5, 
plate  21)  are  sanguine. 

Could  there  be  a  greater  dilTerence  possible  than  is  evident 
in  the  antero-posterior  and  lateral  illustrations?  One  (Fig.  12, 
plate  16)  is  very  high  at  the  middle  or  about  the  first  perma- 
nent molar,  wliile  mesocephale  (Fig.  4,  plate  17)  and  dolicho- 
cephale  (Fig.  4,  plate  21)  are  very  flat.  The  soft  palate  of  a  doli- 
chophale  (Fig.  4,  plate  21)  extends  back  considerably  farther 
than  mesocephale  (Fig.  4). 

Some  (Figs,  i,  3,  5  and  11)  possess  graceful  curves,  but  not 
on  the  same  circle.  The  teeth  also  stand  at  different  angles,  as  in 
the  last  group.  In  the  lateral  illustrations  a  (Fig.  4)  mesocephale 
and  a  (Fig.  5)  dolichocephale  possess  a  slight  resemblance, 
although  the  width  and  height  vary  .12  and  .31  of  an  inch,  respec- 
tively. The  lowest  vault  has  the  widest  jaw,  while  the  highest 
vault  the  narrowest.  There  is  a  depression  at  the  median  line 
which  is  quite  marked  in  the  antero-posterior  illustration  (Fig. 
4.  mesocephalic)  that  is  not  in  the  other.  The  sides  of  the  arch 
(Fig.  4)  diverge  to  a  greater  extent  than  those  in  doHchocephale 
(Fig.  5).     No  two  resemble  each  other. 

The  neurotics  are  said  to  possess  the  highest  vaults.    Brachy- 


246  IRREGULARITIES    OF    THE    TEETH. 

cephales  (Figs.  8,  9  and  10)  and  mesocephales  (Figs.  2,  7  and 
10)  and  dolichocephales  (Figs,  i  and  6)  alike  have  a  nervo-bilious 
or  neurotic  temperament.  The  extreme  highest  vault  is  .75,  the 
extreme  lowest  .37.  In  the  lateral  measurement  the  extreme 
narrowest  i  and  the  extreme  widest,  2.50.  As  far  as  the  shape  of 
the  dental  arch  and  teeth  are  concerned  these  observations  do 
not  correspond  with  Ivy's  in  the  slightest  degree. 

To  illustrate  the  wide  difiference  in  two  individuals  of  the 
same  temperament  take  (Figs.  3  and  4)  two  mesocephales  of 
sanguine  temperament.  One  (Fig.  3)  weighs  195  pounds,  is  six 
feet  two  inches,  while  the  other  (Fig.  4)  weighs  163^  pounds  and 
is  five  feet  eight  inches.  Both  measure  seventy-nine  lateral 
index.  The  two  heads  are  exactly  alike.  The  width  of  vault  in 
(Fig.  3)  is  I,  in  the  other  (Fig.  4)  1.37.  Height  of  vault  (Fig.  3), 
.56;  (Fig.  4),  .50.  The  smaller  man  possesses  the  widest  and 
lowest  arch.  The  shape  of  the  dental  arch,  the  gums  and  teeth, 
are  wholly  unlike.  The  smaller  man  has  the  larger  teeth,  while 
the  gums  are  long  and  pointed.  The  larger  man  has  short,  broad 
gums. 

There  were  three  lymphatic  individuals,  a  brachycephale 
(Fig.  5,  plate  14),  a  mesocephale  (Fig.  9,  plate  20)  and  a  dolicho- 
cephale  (Fig.  3,  plate  21).  Fig.  5  shows  height  of  vault,  .62; 
Fig.  9,  .44;  and  Fig.  3,  .75  ;  while  the  width  of  vault  is.  Fig.  5, 
1.25;  Fig.  9,  I,  and  Fig.  3,  1.25. 

Some  of  the  illustrations  neither  resemble  Ivy's  illustrations 
nor  each  other.  The  same  rule  holds  good  in  the  lymphatic 
temperament  as  in  the  others.  There  is  no  uniformity  in  shape, 
size  or  height. 

The  shape  of  the  vault  is  said  to  resemble  the  shape  or  con- 
tour of  the  head.  Thus  a  brachycephalic  or  broad  head  is  said  to 
contain  a  large,  broad  jaw  with  a  low  vault,  while  a  dolicho- 
cephalic or  long,  narrow,  high  head  should  possess  a  long,  nar- 
row jaw  with  a  high  vault.  To  study  the  relation  of  the  shape 
of  the  vault  with  the  contour  of  the  head,  numerous  models  were 
secured  and  measurements  of  the  head  taken.  The  shape  of  the 
jaws  were  taken  in  modeling  compound  in  such  a  manner  that 
the  soft  palate  could  also  be  outlined.  From  these  impressions, 
plaster  models  were  obtained,  measurements  then  taken  and  the 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  247 

models  sawed  at  the  median  line.  One-half  was  placed  upon 
paper  and  an  outline  obtained.  The  two  halves  were  then  put 
together  and  the  saw  passed  through  the  model  laterally  between 
the  second  bicuspid  and  first  permanent  molar.  The  anterior 
half  was  then  outlined. 

The  shape  of  the  head  was  obtained  by  the  use  of  a  heavy 
strip  of  lead  carefully  moulded  to  the  head  in  the  antero-posterior 
direction  from  the  nose  to  the  base  of  the  skull,  then  removed, 
laid  upon  paper  and  outlined.  The  lateral  contour  was  obtained 
by  moulding  the  lead  over  the  head  just  back  of  the  ears.  These 
outlines  were  reduced  by  means  of  the  pantagraph  to  about  one- 
third  the  natural  size.    A  standard  as  to  skull  types  is  needed. 

According  to  Vogt,'^  "  Taking  the  tables  of  Welcker  as  a 
basis,  and  assuming  the  longitudinal  diameter  of  the  skull — lOO, 
the  following  results  are  obtained  for  the  various  races :  where 
the  mean  of  the  transverse  diameter  is  below  /2,  they  may  be 
termed- long  heads;  where  it  exceeds  8i,  short  heads;  where  it 
varies  between  74  and  81,  middle  heads." 

Later  craniologists,  as  already  shown,  generally  assume  two 
fundamental  types,  the  dolichocephalous  or  long  horizontally, 
that  is,  from  back  to  front,  and  the  brachycephalous  or  approxi- 
mately round  horizontally. 

My  own  results  support  Keane.  Dolichocephaly  was  found 
to  be  exceedingly  rare  in  the  white  and  very  infrequent  among 
the  fiegroes.    The  results  are  to  be  found  in  the  appendix. 

Examination  of  the  brachycephalic  whites  show's  the  first  six 
lateral  indexes  are  84.  The  width  of  the  dental  arch  varies  from 
2.12  to  2.62;  outside  second  bicuspids,  from  1.75  to  2.37;  Avidth 
of  vault  between  second  bicuspids  from  i  to  1.37;  antero- 
posterior, from  1.87  to  2.27,  while  the  height  of  the  vault  varies 
from  .44  to  .62.  In  the  mesocephalic,  white,  the  range  varies 
from  2  to  2.50  in  width  of  dental  arch ;  width  outside  of  second 
bicuspids,  from  1.62  to  2.25  :  width  inside  second  bicuspids  from 
I  to  1.86;  antero-posterior  from  2  to  2.37,  and  height  of  vault 
from  .31  to  .68.  Dolichocephalic:  The  range  width  of  dental 
arch  is  from  2  to  2.37:  width  outside  second  bicuspids,  1.87  to 

*  Lectures  on  Man. 


248  IRREGULARITIES    OF    THE    TEETH. 

2.12;  width  betwen  second  bicuspids,  from  1.25  to  1.50;  antero- 
posterior from  2.12  to  2.31 ;  height  of  vault  from  .62  to  .81. 

The  range  of  figures  in  each  group  is  so  great  and  differs 
so  much  from  each  other  that  no  two  seem  to  resemble  each 
other.  By  comparison  of  one  group  with  another,  it  is  seen 
there  is  very  little  difference  as  regards  width  and  length  of 
dental  arch  and  width  of  vault.  There  is,  however,  a  difference 
in  height  of  vault. 

The  figures  in  the  table  of  the  lateral  index  do  not  show  the 
slightest  resemblance  in  width,  height  or  temperament,  nor  the 
least  agreement  in  contour  of  the  vault  and  head.  The  shape 
of  the  vault  is  said  to  be  influenced  by  the  intellect  of  the  indi- 
vidual ;  that  is,  the  most  intellectual  people  possess  the  highest 
vaults.  To  test  this  theory,  six  brachycephalic  (Plates  23  and 
24),  six  mesocephalic  (Plates  25  and  26),  and  six  dohchocephalic 
(Plates  27  and  28),  negro  waiters  in  hotels  and  restaurants,  were 
measured.  The  whites  were  bankers,  editors,  medical  men,  stu- 
dents, architects,  bookkeepers. 

By  comparing  the  brachycephalic  heads  we  notice  that  the 
highest  lateral  index  in  the  white  individuals  is  84.  in  negro  87. 
The  highest  width,  outside  of  first  permanent  molar,  is  white, 
2.62;  colored,  2.87.  This  seemed  to  be  quite  remarkable.  The 
lowest  white  2,  negro  2.25.  In  width  of  vault  between  second 
bicuspids,  highest  white  1.37,  negro  1.62;  lowest  white  i,  negro 
1.31.  Antero-posterior  greatest  length,  white  2.50.  negro  2.25. 
Height  of  vault,  highest  white  68,  lowest  37,  with  an  average  of 
54;  negro  highest  75,  lowest  50,  with  an  average  of  61. 

Mesocephalic — Highest  lateral  index,  white  79,  colored  80. 
Highest  width  outside  first  permanent  molar,  white  2.50,  negro 
2.81 ;  lowest,  white  2,  negro  2.12.  Width  of  vault  between  sec- 
ond bicuspids,  highest,  white  1.86,  colored  1.62;  lowest,  white  i, 
negro  1.3 1.  Antero-posterior,  highest,  white  2.37,  nego  2.37; 
lowest,  white  2,  negro  2.  Height  of  vault,  highest,  white  .68, 
negro  .62;  lowest,  white  .31,  negro  .50;  average,  white  .52, 
negro  .60. 

Dolichocephalic — Highest  lateral  index,  white  72,  negro  70. 
Greatest  width  outside  first  molar,  white  2.37,  negro  2.50;  low- 
est, white   2,   colored   2.12.     Width   of  vault   between   second 


DEVELOI'MKNTAL    KEUROSES    OF    THE    VAULT,  249 

bicuspids,  highest,  white  1.50,  negro  i./S;  lowest,  white  1.25,  col- 
ored 1. 18. 

Antero-postcrior — Greatest  length,  white  2.31,  negro  2.37; 
smallest,  white  2.12,  negro  2.18.  Height  of  vault,  highest,  white 
.81,  negro  .68;  lowest,  white  .62,  negro  .56;  average,  white  .74, 
negro  .62. 

The  negro  has  the  roundest  heads,  while  the  width  of  jaws 
is  larger  in  white,  but  in  the  other  divisions,  the  jaws  are  more 
uniform  in  width.  The  jaw  does  not  diminish  in  the  negro  in 
width  anterior  to  the  first  permanent  molar  as  it  does  in  the 
Caucasic  race.  The  height  of  vault  is  much  higher  in  the  negro 
than  in  the  white,  with  the  exception  of  the  dolichocephalic 
heads,  where  it  is  higher  in  the  white.  The  height  of  vault, 
like  other  measurements,  is  more  uniform  in  the  white.  Com- 
paring the  figures  of  the  negro  with  the  white  people,  it  will  be 
seen,  in  the  average  that  the  width  and  antero-posterior  meas- 
urements of  the  negro  are  the  largest. 

Since  the  highest  vaults  in  the  brachycephalic  and  meso- 
cephalic  heads  are  found  in  negroes  and  in  the  dolichocephalic 
among  the  white,  it  is  evident  that  intelligence  has  no  relation 
with  the  contour  of  the  vault.  Comparison  can  no  more  be  made 
between  the  vault  and  the  contour  of  the  heads  in  negroes  than 
there  is  in  whites. 

Mouth  breathing  has  been  advanced  as  a  cause  of  high 
vaults.  This  view  is  till  held  by  dentists  and  medical  men. 
Mouth-breathing  is  caused  by  sleeping  with  the  mouth  open, 
by  enlarged  tonsils,  by  adenoid  growth,  by  hypertrophy  of  the 
mucous  membrane  of  the  nose  and  turbinated  bones  and  by 
arrest  of  development  of  the  bones  of  the  jaw  and  nose.  When 
the  mouth  is  opened,  pressure  is  said  to  be  produced  upon  the 
sides  of  the  jaws  and  teeth  by  tension  of  the  buccinator  muscle, 
causing  contraction  of  the  sides  of  the  jaw,  protrusion  of  the 
teeth  and  elevation  of  the  vault. 

The  superior  maxillary  bones  are  fused  at  the  median  line. 
Their  under  surfaces  have  imposed  upon  them  the  alveolar  proc- 
esses. The  maxillary  bones  proper  are  made  up  of  dense,  com- 
pact tissue  and  are  so  arranged  as  to  best  resist  certain  forces. 
The  outer  surface  of  the  bone  is  fortified  and  supported  by  the 


250  IRREGULARITIES    OF    THE    TEETH. 

malar  process,  which  is  situated  midway  between  the  maxillary 
process  and  the  canine  eminence  at  the  first  permanent  molar. 
At  the  canine  eminence  is  the  strong,  thick  plate  of  bone  extend- 
ing from  the  bridge  of  the  nose  to  the  alae,  the  mesial  portion 
forming  the  outer  surface  of  the  nasal  cavity.  The  nasal  septum 
is  situated  at  the  center  of  the  nares  and  is  attached  to  the 
maxillary  bone  at  and  along  the  place  of  union  of  the  two  halves 
of  the  maxillary  bone.  A  saw  passed  through  from  one  canine 
fossa  to  the  other  discloses  in  the  section  the  strong  trilateral  pil- 
lars of  bone  which  go  to  make  up  the  outer  surfaces  of  the  nasal 
cavity.  These  strong  pillars  of  bone  are  situated  just  at  the  point 
of  the  location  of  the  permanent  cuspids  and,  together  with  the 
nasal  septum,  form  a  strong  support  to  the  hard  palate. 

Maxillary  bones  are  for  the  attachment  of  muscles  and  the 
resistance  of  force  in  masticating  food.  The  hard  palate  does 
not  assume  the  normal  shape  until  the  twelfth  year,  or  after  the 
teeth  are  all  in  position.  The  vault  may  be  high  or  low,  ranging 
from  one  inch  vertically  from  the  alveolar  plane  on  a  transverse 
line  intersecting  the  alveolar  crests  between  the  second  bicus- 
pids and  first  molars  down  to  one-quarter  of  an  inch  from  the 
plane.  In  either  case  the  vault  may  be  normal,  since  each  variety 
depends  upon  the  shape  of  the  maxillary  bones  and  teeth  for  its 
peculiar  form. 

The  alveolar  process,  consisting  of  soft,  cancellated  structure, 
is  solely  for  the  purpose  of  protecting  the  germs  of  the  teeth 
before  they  have  erupted,  and  for  supporting  the  teeth  after 
they  are  in  place.  From  the  time  the  teeth  make  their  appear- 
ance until  they  are  shed,  the  alveolar  process  has  developed  and 
been  absorbed  three  times.  The  alveolar  process  being  solely 
for  pl-otection  and  support  of  the  teeth,  its  position  and  shape 
must  depend  upon  the  location  of  the  teeth.  The  bone  proper 
is  not  influenced  to  any  great  extent  by  the  movement  of  the 
teeth. 

The  buccinator  is  a  voluntary  muscle,  penniform  in  shape.  It 
has  its  origin  and  insertion  along  the  body  of  the  jaws,  above 
the  alveolar  process  on  the  upper  and  below  the  alveolar  process 
on  the  lower  jaw.  It  extends  from  the  first  bicuspid  anteriorly 
to  the  wisdom-tooth  posteriorly.    The  center  of  the  muscle  in 


DEVELOPMENTAI-  NEUROSES  OF  THE  VAULT. 


251 


one  direction  is  therefore  on  a  line  with  the  j^Hnding  surface  of 
the  teeth  and  in  a  transverse  direction  at  the  first  permanent 
molar.  Its  chief  function  is  to  convey  and  hold  the  food  under 
the  teeth  during  mastication. 

In  many  cases  of  contracted  arches  and  high  vaults,  mouth- 
breathing  does  not  occur.  In  many  cases  of  normal  arches  and 
vaults  it  co-exists.  Mouth-breathing  frequently  commences  very 
early  in  life ;  contracted  jaws,  on  the  other  hand,  never  begin 
until  the  seventh  or  eighth  and  in  most  cases  the  tenth  year, 
except  monstrosities  or  from  traumatic  causes.  These  conditions 
when  existing  are  wholly  unlike  the  usual  contracted  arches,  can 


Fig.  90. 

be  diagnosticated  at  once,  and  therefore  they  should  not  enter 
into  this  discussion.  Contracted  arches  are  of  two  kindsi — V 
(Fig.  90),  and  saddle-shaped  (Fig.  91) — all  other  varieties  being 
modifications  of  these  two.  The  cause  which  produces  the  one 
cannot  produce  the  other.  There  are  two-thirds  more  V  and 
saddle-shaped  arches  among  the  low  vaults  than  among  the 
high  vaults,  taking  .58  of  an  inch  as  the  average.  One  of  these 
deformities  with  a  high  vault  is  always  more  marked,  since  in 
the  high  vault  the  alveolar  process  is  long  and  thirr,  with  very 
little  resistance,  and  the  teeth  are  more  easily  carried  in  one 
direction  or  the  other. 


252 


IRREGULARITIES    OF    THE    TEETH. 


In  the  V-shaped  arch,  commencing  at  the  first  permanent 
molar,  there  is  a  gradual  narrowing  of  the  dental  arch  and  alveo- 
lar process  toward  the  median  line,  where  the  incisors  may 
approximate  a  V  point  or  may  stand  in  their  normal  position 
to  each  other.  Invariably  there  is  protrusion  of  the  teeth  and 
alveolar  process,  not  of  the  jaw.  In  the  saddle-shaped  arch  the 
bicuspids  are  carried  inward  and  the  deformity  is  invariably 
situated  between  the  first  permanent  molar  and  the  cuspid. 
Unlike  the  V-shaped  variety,  the  anterior  teeth  and  alveolar 
process  never  protrude  in  this  class  of  deformities.  The  con- 
tracted   hard    palate    is    always    associated    with    the    V-shaped 


lilli  lijiil^^  "'""limWII* 

Fig.  91. 

variety,  in  most  cases  extends  backward  to  the  second  bicuspid 
and  is  never  seen  with  the  saddle-shaped  variety. 

The  high  vault  is  never  seen  in  the  first  set  of  teeth,  nor  does 
it  develop  until  the  second  set  are  all  in  place,  which  is  at  the 
twelfth  year.  The  vault  commences  to  slope  slightly  from  the 
neck  of  the  incisor  until  it  reaches  an  imaginary  line  drawn  across 
the  roof  of  the  mouth  from  the  right  first  bicuspid  to  the  left 
first  bicuspid,  here  it  gradually  or  abruptly  slopes  upward  until 
a  point  is  reached  which  is  central  and  vertical  to  a  line  drawn 
across  the  jaw  from  crest  to  crest  between  the  second  bicuspids 
and  first  molars.  From  this  point  posteriorly  to  the  soft  palate 
the  dome  is  usually  nearly  level  and  parallel  with  the  plane  of 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  253 

the  alveolar  crests  of  the  bicuspids  and  molars  when  it  gradually 
slopes  and  unites  with  the  soft  palate.  Occasionally  there  is  a 
slight  depression  and  sometimes  a  corresponding  slight  eleva- 
tion. These  arc  so  inconsideratable  as  to  escape  notice  unless 
looked  for.  d  |  -  j 

In  mouth-breathing  the  lower  jaw  usually  drops  only  suffi- 
ciently for  the  passage  of  the  same  volume  of  air  that  would 
pass  through  the  nasal  cavities  when  in  a  normal  condition.  Each 
of  the  openings  to  which  is  equal  to  about  one-half  an  inch  in 
transverse  area.  Old  people  often  sleep  with  the  mouth  open 
and  to  the  fullest  extent.  These  deformities  of  the  jaws  and 
teeth  never  occur  after  the  eruption  of  the  teeth,  about  the 
twelfth  to  fifteenth  year. 

On  opening  the  mouth  there  is  a  sense  of  tension  of  the 
orbicularis  oris,  but  not  of  a  pressure  of  the  buccinator,  no  matter 
how  widely  the  mouth  may  be  open.  This  muscle  being  under 
the  control  of  the  will,  is  always  passive,  except  in  the  act  of 
blowing  or  eating.  Contraction  during  sleep  is  out  of  the  ques- 
tion. As  the  buccinator  muscle  extends  anteriorly  to  the  first 
bicuspid  only,  it  cannot  be  productive  of  the  V-shaped  variety 
of  deformity,  in  which  is  also  found  the  contracted  vault.  There- 
fore the  only  deformity  that  might  be  so  produced  is  the  saddle- 
shaped  variety.  The  orbicularis  oris  muscle  cannot  produce  the 
contraction,  because  when  the  mouth  is  open  the  pressure  on  the 
six  anterior  teeth  is  backward.  Thus  the  teeth  should  be  carried 
in  the  opposite  direction  from  that  which  must  be  taken  to 
produce  this  deformity.  The  pressure  is  just  as  great  upon  the 
incisors  as  upon  the  cuspids,  thus  holding  them  in  place.  More 
force  is  exerted  by  the  orbicularis  oris  upon  the  six  anterior 
teeth  when  the  mouth  is  open  than  could  be  exerted  by  the 
buccinator  muscle,  which  would  tend  to  hold  the  anterior  teeth 
in  place.  Apices  of  teeth  rarely  move  when  pressure  is  brought 
to  bear  upon  their  crowns  for  the  purpose  of  regulating  them. 
Teeth  having  long  roots  like  the  cuspids  are  hence  less  liable 
to  move  than  teeth  with  short  roots  like  the  lateral  incisors  and 
bicuspids.  Since  in  moving  a  tooth  the  greatest  change  takes 
place  at  the  neck  the  greatest  absorption  and  deposition  of  bone 
must  take  place  at  that  point.     The  roots  of  the  cuspids  are 


254 


IRREGULARITIES    OF    THE    TEETH. 


larger  and  longer  than  those  of  any  other  teeth  in  the  jaw.  Un- 
like other  teeth,  the  germs  are  situated  considerably  higher  and 
farther  toward  the  outside  of  the  alveolar  process,  hence  when 
they  come  closely  into  position  they  diverge  from  the  apices  tp 
the  crowns.  All  other  teeth  stand  nearly  or  quite  perpendicular, 
hence  the  roots  of  these  teeth  do  not  influence  the  hard  palate. 
The  first  permanent  molar  and  the  teeth  posterior  to  it  are  never 
involved,  except  from  local  causes.  The  center  of  the  buccinator 
muscle  in  both  directions  is  located  at  this  tooth.  How.  then, 
since  all  the  teeth  are  covered  by  the  muscle  upon  one  side, 
can  half  be  carried  inward  and  the  other  half  remain  normal? 


Fig.  93. 

Again,  were  mouth-breathing  the  cause  of  the  contraction, 
both  sides  should  contract  alike,  and  the  deformity  be  uniform 
upon  both  sides.  This  is  never  the  case.  The  want  of  uniformity 
of  the  two  sides  is  easily  recognized.  Muscles  cannot  contract 
to  a  degree  sufificient  to  induce  the  pressure  necessary  to  produce 
a  deformity.  Some  of  the  muscles  of  the  chest  exert  much  more 
pressure  in  respiration  than  it  is  possible  for  the  buccinator  to 
do  during  sleep,  yet  no  one  would  expect  to  find  the  ribs  mod- 
ified by  this  process.  Pressure  of  the  contractile  tissue  upon 
the  crowns  of  teeth  is  not  sufificient  to  affect  the  alveol-r 
process  through  the  roots  of  the  teeth.  Even  if  it  could  modify 
that  spongy  structure,  its  force  must  stop  there  and  would  not 
extend  to  the  osseous  vault  and  result  in  bending  it  out  of  shape. 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT. 


255 


In  most  cases  the  diameter  of  the  superior  maxilla,  its  alveolar 
process  and  teeth  is  less  than  that  of  the  inferior  maxilla,  alveo- 
lar process  and  teeth.  This  is  al\va\  s  the  case  in  the  worst  forms 
of  irregularities  of  the  teeth.  In  such  cases,  the  muscles  and 
cheek  could  not  press  upon  the  teeth  and  alveolar  process  of  the 
upper  jaw.  The  changes  which  take  place  in  the  bone  are  not 
a  bending  in  at  one  place  and  a  forcing  out  at  a  weaker  point  to 
compensate  for  the  space  lost,  but  an  absorption  and  deposition 
of  bone  at  the  point  of  pressure.  Even  if  these  last  conditions 
were  the  case,  the  strong  pillar  of  bone  situated  at  the  very  point 
of  contraction  of  the  alveolar  process,  together  with  the  nasal 


Fig.  93. 

septum  would  constitute  a  strong  bulwark  for  resistance  to  the 
pressure,  w'hich  is  suppositiously  acting  at  a  distance  from  the 
top  of  the  vault.  It  would  be  as  impossible  to  produce  sufficient 
pressure  to  break  the  dental  arch  as  it  would  be  for  the  weight 
of  a  building  to  break  the  arch  of  a  door  or  window.  The  tongue 
exerting  much  greater  force  in  the  act  of  swallowing,  would 
prevent  inward  movement  of  the  teeth  if  the  slight  pressure 
from  the  cheek  muscles  were  the  cause  of  the  deformity. 

Were  it  possible  for  the  buccinator  muscle  to  produce  this 
contraction,  the  modification  of  the  osseous  structures  must  be 
uniform.  This  would  shut  out  the  semi-V-shaped  (Fig.  92)  and 
semi-saddle-shaped  arches  entirely  (Fig.  93),  and  a  majority  of 


256 


IRREGULAKITIES    OF    THE    TEETH. 


Other  irregularities  of  the  teeth  in  which  there  is  bilateral  asym- 
metry. The  bilateral  muscle  cannot  act  on  one  side  while  that 
on  the  opposite  side  remains  passive.  Partial  V-shaped  (Fig.  94) 
and  partial  saddle-shaped  (Fig.  95)  arches  make  the  theory  still 
less  tenable.  In  these  varieties  are  sudden  bends  inward  where 
only  one  or  two  teeth  may  be  involved.  These  aberrations  could 
only  be  produced  by  a  centralization  of  force  on  one  given  point 
or  fiber  of  muscle.  The  muscle  being  penniform  in  shape,  it 
would  be  impossible  for  one  or  two  fibers  of  the  muscle  to  exert 
their  influence  upon  a  bicuspid.  It  would  naturally  lap  two  or 
more  teeth.     Lastly,  if  the  buccinator  acts  as  all  muscles  do — 


Kig.  94. 


uniformly  throughout  its  extent  of  contraction — it  is  just  as 
efficient  below  a  median  bisecting  line  in  producing  a  narrow, 
contracted  arch  as  in  its  upper  portion.  Therefore,  the  lower 
maxilla  should  be  contracted  whenever  the  upper  one  is,  an 
evident  impossibility.  A  V-shaped  arch  can  never  occur  upon 
the  lower  jaw  if  the  teeth  articulate  normally,  because  these 
teeth  strike  inside  of  the  upper  and  are  thus  prevented  from 
moving  forward.  A  saddle,  partial  saddle  or  semi-saddle  arch 
may  occur  on  the  lower  jaw,  but  these  deformities  are  not  often 
seen.  When  they  do  occur,  they  are  the  result  of  improper 
occlusion  with  the  teeth  of  the  upper  jaw.  In  semi-V  and 
partial  V-shaped  arches  the  alveolar  process  is  always  contracted 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT. 


257 


upon  the  side  of  the  deformity.  If  one  side  of  the  arch  be 
contracted  more  than  the  other,  the  alveolar  process  is  con- 
tracted in  proportion  to  the  amount  of  deformity ;  the  vault  on 
that  side  is  not  carried  up  beyond  the  other  side,  which  is  normal. 
In  the  saddle,  semi-saddle  and  partially  saddle-shaped  arches, 
the  alveolar  process  is  built  up  about  the  teeth  in  precise  con- 
formity to  the  nature  of  the  shape  of  the  arch.  If  three  thousand 
models  of  the  upper  jaw  were  arranged  in  groups  according  to 
the  forms  here  represented  and  the  arrangement  of  the  teeth  in 
each  group  examined  very  closely,  no  two  are  alike  in  either 
group.    An  external  force  acting  upon  the  jaws  from  the  outside 


Fig.  95. 

could  hence  not  possibly  be  a  cause.  If  that  were  possible  all 
models  of  one  variety  would  have  a  definite  type  (Table  XXIX). 

In  order  to  further  settle  the  question  of  mouth-breathing, 
I  present  the  following  models  of  patients  over  twelve  years  of 
age.  They  number  from  i  to  24,  the  order  in  which  the  impres- 
sions were  taken.  A  sufficient  number  of  cases  are  here  illus- 
trated to  show  the  general  outline  of  the  jaws  and  teeth  of  the 
average  mouth-breather. 

Very  few  of  these  cases  have  contracted  arches,  as  a  rule,  the 
vaults  are  less  than  the  average  in  height.  No  two  cases  are 
exactly  alike,  which  would  be  the  case  if  the  contracted  jaws 
were  caused  by  lateral  pressure  of  the  cheeks.  Many  cases  were 
seen  in  consultation  with  Hawley,  H.  H.  Brown  and  Pynchon. 

18 


258  IRREGULARITIES    OF    THE    TEETH. 

Case  I,  Fig.  96.  A  thirteen  year  old  boy  of  Canadian-French 
extraction,  born  in  Chicago.  Height  of  vault,  .53  of  an  inch. 
Has  always  breathed  through  the  mouth.  Adenoid  growth  in 
post-nasal  spaces.  Collapsed  condition  of  alae  nasi.  The  teeth 
were  late  in  erupting.  The  bicuspids  were  all  through  upon  the 
right  side.  The  cuspid  was  just  coming  into  place,  while  upon 
the  left  side  the  second  temporary  molar  was  yet  in  position. 
The  first  molar  had  just  been  removed.  The  first  bicuspid  was 
coming  in  its  place.  The  cuspid  was  not  so  far  developed  as 
its  fellow  of  the  opposite  side.  The  second  permanent  molars 
should   have   been   in   place,   but  were  tardy   in   development. 


FiR.  'JG. 


While  the  general  contour  of  the  jaw  was  normal  posterior  to 
the  cuspids,  there  was  a  tendency  of  the  incisors  to  contraction, 
with  a  protrusion  of  the  mesial  surface  of  the  centrals.  The 
cuspids  were  erupting  anterior  to  their  normal  position,  thus 
crowding  the  incisors  together. 

Case  H,  Fig.  97.  A  nineteen  year  old  boy,  American.  Height 
of  vault,  .75  of  an  inch.  He  commenced  to  breathe  through 
the  mouth  at  the  age  of  nine  years,  at  which  time  his  nose  was 
broken.  There  was  arrest  of  development  of  the  bones  of  the 
nose.  There  were  adenoid  growths.  Hearing  and  eyesight  were 
poor. 

The  jaw  in  this  case  was  well  developed  with  a  normal  palate, 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT. 


259 


but  higher  than  the  average,  being  three-fourths  of  an  inch  in 
height.  All  the  teeth  had  erupted.  The  anterior  teeth  had  a 
tendency  to  contraction,  due  to  tendency  of  the  teeth  to  push 
forward.  The  central  incisors  did  not  protrude,  as  in  Case  I, 
because  the  lateral  incisors  overlapped  them.  The  right  side  of 
the  arch  tended  to  assume  the  saddle-shaped  deformity  from  the 
position  of  the  bicuspids,  caused  by  too  long  retention  of  the 
temporary  teeth.  The  two  sides  were  markedly  asymmetrical. 
This  case  shows  that  were  contraction  of  the  jaw  due  to  con- 
traction of  muscles  in  mouth-breathing,  both  sides  would  be 
alike. 


Fig.  9' 


Case  III,  Fig.  98.  A  thirteen  year  old  American  girl.  Height 
of  vault,  .46  of  an  inch.  She  had  scarlet  fever  at  the  age  of  five 
years  and  commenced  to  breathe  through  the  mouth  at  eight. 
There  was  arrest  of  development  of  the  bones  of  the  face  and 


nose. 


This  was  a  well-marked  case  of  defective  development  of  the 
superior  maxilla  and  arrest  of  development  of  the  bones  of 
the  face  and  nose.  As  in  Case  I,  the  second  molars  had  not  yet 
made  their  appearance.  The  central  incisors  overlapped,  but  did 
not  protrude.  The  right  side  of  the  arch  tended  to  assume  the 
saddle-shaped  deformity  from  the  position  of  the  bicuspids.  The 
cuspid  had  not  fully  erupted  on  this  side  and  was  still  more 


260 


IRREGULARITIES    OF    THE    TEETH. 


tardy  in  its  appearance  on  the  left.  The  two  sides  were  asym- 
metrical and  the  height  of  the  vault  a  little  less  than  the  average. 
When  the  second  and  third  molars  appear,  an  unusual  protrusion 
of  the  anterior  teeth  must  necessarily  result  in  order  to  give 
sufficient  room  for  the  molars.  If  this  were  allowed  to  progress 
without  mechanical  interference  a  marked  V-shaped  deformity 
would  result. 

Case  IV,  Fig.  99.  A  twenty-one  year  old  American.  Height 
of  vault,  .68  of  an  inch.  He  had  been  a  mouth-breather  all  his 
life.  There  was  deflection  of  the  septum  nasi  which  at  the  age 
of  fourteen  was  operated  upon  without  any  result.    The  bones  of 


Fig.  98. 

the  nose  were  well  developed.  Those  of  the  face  were  slightly 
arrested. 

While  the  jaw  was  not  quite  as  large  as  normal,  the  teeth 
were  regular,  well  developed  and  without  a  cavity.  A  more 
nearly  perfect  arch  is  rarely  found.  The  articulation  with  the 
inferior  maxilla  was  at  all  times  exact. 

Case  V,  Fig.  100.  A  fifty-two  year  old  American.  Height 
of  vault,  .43  of  an  inch.  He  always  breathed  through  the  mouth. 
The  bones  of  the  nose  and  face  were  well  developed.  A  year 
before  coming  under  care  had  had  hypertrophied  bone  removed 
from  nose.  Eyesight  and  hearing  are  good.  The  jaw  is  well 
developed  and  shows  no  deformity. 

Case  VI,  Fig.  loi.     A  seventeen  year  old  American  girl. 


DEVELOPMKNTAI,    NEUROSES    OF    THE    VAULT. 


261 


Height  of  vault,  .65  of  an  inch.  She  has  not  always  breathed 
through  the  mouth.  She  had  adenoid  growths.  She  had  had 
measles  and  chicken-pox.  This  jaw  was  considerably  contracted 
throughout,  but  more  noticeably  through  its  lateral  diameter. 
The  alveolar  process  was  hypcrtrophied  on  either  side,  the 
hypertrophy  being  more  marked  on  the  right  side. 

Case  VII,  Fig.  102.  A  seventeen  year  old  American  girl. 
Height  of  vault,  .65  of  an  inch.  She  had  always  breathed  through 
the  mouth  and  had  had  post-nasal  catarrh.  She  had  had  measles 
and  whooping-cough.  The  jaw  was  arrested  in  its  development. 
The  first  bicuspids  had  been  extracted  to  make  room  for  other 


Fig  99. 


teeth.  The  lateral  incisors  overlapped  the  centrals  because  of  a 
lack  of  room  before  extraction  of  the  bicuspids.  The  jaw  was 
asymmetrical,  the  left  side  diverging  to  allow  eruption  of  second 
molar. 

Case  Vni,  Fig.  103.  ^n  eighteen  year  old  American  boy. 
Height  of  vault,  .59  of  an  inch.  He  always  breathed  through 
the  mouth.  He  had  scarlet  fever  at  eighteen  months.  He  received 
a  blow  upon  the  nose  which  caused  left  deflection  of  the  septum 
nasi.  The  left  nostril  was  entirely  closed  by  hypertrophy  of 
bone  and  mucous  membrane.  There  was  slight  hypertrophy  of 
the  mucous  membrane  of  the  right  nostril  and  hypertrophy 
of  the  mucous  membrane  in  the  post-nasal  space.    There  was 


262 


IRREGULARITIES    OF    THE    TEETH. 


arrest  of  development  of  the  bones  of  the  nose.  This  case  has 
marked  arrest  of  development  of  the  entire  jaw.  The  anterior 
teeth  were  much  crowded.  On  the  left  side  the  left  lateral  incisor 
had  rupted  within  the  arch ;  that  of  the  right  side  partially.  The 
cuspids  had  erupted  outside  of  the  arch.  On  the  right  side  the 
sixth  year  molar  had  been  extracted,  in  consequence  of  which  the 
second  molar  had  been  pushed  forward. 

In  this  case  the  small  jaw  was  inherited  from  the  mother  and 
in  harmony  with  the  bones  of  the  face.  The  teeth  which  were 
exceedingly  large  and  had  long  roots  were  inherited  from  the 
father.  They  were  so  out  of  proportion  to  the  small  jaw  that 
the  posterior  teeth  had  moved  forward  and  filled  the  spaces 
intended  for  the  cuspids. 


Fig. '.100. 

Case  IX,  Fig.  104.  An  American  medical  student,  aged 
twenty-five.  Height  of  vault,  .71  of  an  inch.  He  commenced  to 
breathe  through  the  mouth  at  ten.  There  was  marked  arrest 
of  development  of  the  bones  of  the  face  and  nose.  The  nasal 
cavities  were  small.  The  nasal  septum  was  deflected  slightly 
to  the  right.  There  was  hypertrophy  of  cartilage  on  the  left 
side.  The  mucous  membrane  was  slightly  thickened.  The  pos- 
terior nasal  cavities  were  clean. 

The  patient  had  measles,  chicken-pox,  mumps  and  two 
attacks  of  pneumonia.  He  had  severe  rheumatism  at  twenty- 
one.  At  the  time  of  examination  there  was  tuberculosis  of  the 
left  ankle. 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT. 


263 


On  examination  of  the  jaws,  it  was  found  that ;  The  lower 
jaw  was  excessively  large.  Although  all  of  the  teeth  of  the 
lower  jaw  tip  inward,  yet  the  outer  cusps  of  the  upper  teeth 
just  touch  the  inner  cusps  of  the  lower  teeth.  There  was 
marked  arrest  of  development  of  the  upper  jaw.  On  the  right 
side  the  arch  had  a  tendency  to  assume  the  saddle-shaped 
deformity.  On  this  side  the  cuspid  had  erupted  externally  to 
the  arch.  Between  the  central  and  the  lateral  incisors  its  mesial 
surface  was  directed  inward.  The  lateral  incisor  was  internal  to 
the  other  teeth.  The  lateral  incisor  on  the  left  side  was  situated 
internally  to  the  central  incisor  and  cuspid.  It  had  caused  a 
slight  rotation  of  the  central  incisor.    The  second  molars  were 


Fig.  lOL 

small  and  had  erupted  externally  to  the  first  molar  on  account 
of  lack  of  room  in  the  jaw.  The  alveolar  process  and  mucous 
membrane  were  hypertrophied.  At  the  time  of  formation  of  the 
irregularities  of  the  teeth  the  alveolar  process  and  mucous  mem- 
brane began  to  hypertrophy.  Coincidently  with  these  there 
was  arrest  of  development  of  the  bones  of  the  face,  nose  and 
jaw  and  the  habit  of  mouth-breathing  was  formed. 

Case  X,  Fig.  105.  A  thirty-four  year  old  German.  Height 
of  vauh,  .71  of  an  inch.  He  had  always  breathed  through  the 
mouth  until  an  operation  four  years  previous  to  examination. 
He  had  had  scarlet  fever  and  measles.    This  jaw  was  well  devel- 


264  IRREGULARITIES    OF    THE    TEETH. 

oped.  The  central  incisors  overlap  slightly  from  the  result  of 
interstitial  gingivitis.  The  left  side  had  a  tendency  to  assume  the 
saddle-shaped  deformity  from  the  position  of  the  bicuspids.  This 
was  probably  assumed  because  of  too  long  retention  of  the  tem- 
porary teeth.  The  crowns  of  the  molars  had  decayed  and  broken 
oflf.  The  thickening  of  the  mucous  membrane  was  the  result 
of  interstitial  gingivitis. 

Case  XI,  Fig.  io6,  A  thirteen  year  old  American  boy. 
Height  of  vault,  .62  of  an  inch.  He  had  breathed  through  the 
mouth  for  six  years,  before  coming  under  observation.  There 
was  arrest  of  development  of  the  bones  of  the  face  and  nose. 
The  patient  had  considerable  catarrh  and  had  been  treated  for 
irregularities  of  the  teeth.    The  jaw  was  much  contracted,  espe- 


Fig.  102.  -> 

dally  in  the  anterior  part.  On  the  right  side  the  lateral  incisor 
was  deformed  and  represented  by  a  conical  tooth  situated  intern- 
ally to  the  other  teeth.  Posterior  to  this  was  the  temporary 
cuspid.  Because  of  retention  of  this  tooth  the  permanent  cuspid 
was  erupting  externally  to  the  other  teeth  and  between  the  tem- 
porary cuspid  and  permanent  central  incisor.  On  the  left  side 
the  lateral  incisor  was  deformed  in  a  similar  manner  to  that  on 
the  right,  but  its  position  was  normal.  The  left  temporary 
cuspid  remained.  As  there  was  insufficient  room  in  the  jaw  for 
the  second  molars,  the  teeth  anterior  to  these  moved  forward, 
producing  the  V-shaped  projection  of  the  central  incisors. 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT. 


265 


Case  XII,  Fig.  107.  A  fifteen  year  old  American.  Height 
of  vault,  .53  of  an  inch.  There  was  deflection  of  septum  nasi 
and  thickenintj:  of  nuicous  mcmhrane.  The  initient  had  always 
breathed  throui^li  the  mouth.  The  small  jaw  was  inherited  from 
the  mother  and  the  large  teeth  from  the  father.  The  dental  arch 
was  contracted  anterior  to  the  cuspids  and  the  anterior  teeth 
were  crowded.  Posterior  to  the  cuspids  the  dental  arch  was 
normal.  The  first  bicuspid  on  the  left  side  had  been  removed 
to  afford  more  room  for  the  outer  teeth.  The  corresponding 
tooth  on  the  right  should  also  have  been  removed.  As  it  was 
allowed  to  remain  it  caused  a  crowded  condition  on  that  side. 
The  incisor  passed  beyond  the  median  line  of  the  jaw,  encroach- 


Fig.  103. 

ing  upon  the  other  side.  Because  of  insufficient  room  in  the 
jaw  for  the  second  molars,  the  teeth  anterior  to  these  had 
pushed  forward,  producing  the  V-shaped  protrusion  of  the  cen- 
tral incisors. 

Case  XIII,  Fig.  108.  A  twenty  year  old  man.  Height  of 
vault,  .71  of  an  inch.  He  had  always  breathed  through  the 
mouth.  The  alveolar  process  was  well  developed.  The  max- 
illary bones  were  arrested  in  their  development.  The  left  nostril 
was  entirely  closed.  There  was  hypertrophy  of  the  mucous 
membrane  of  the  right  nostril.  He  had  had  scarlet  fever  and 
whooping-cough.  There  was  arrested  development  of  the  max- 
illary bones  in  this  case,  but  no  deformity  had  been  produced  as 


266 


IRREGULARITIES    OF    THE    TEETH. 


the  teeth  had  crowded  the  alveolar  process  upon  the  outer  sur- 
face of  the  bone,  thus  forming  a  large  arch.  The  only  irregu- 
larity of  the  teeth  was  on  the  right  side,  where  the  lateral 
incisor,  by  erupting  slightly  within  the  arch  had  pushed  the  distal 
surface  of  the  central  incisor  slightly  outward. 

Case  XIV,  Fig.  109.  A  thirty-nine  year  old  Canadian. 
Height  of  vault,  .71  of  an  inch.  He  had  always  breathed  through 
the  mouth  until  he  came  to  Chicago,  in  1884.  since  which  time 
he  had  gradually  improved  and  could  breathe  at  time  of  exam- 
ination partially  well.  He  had  always  suffered  from  catarrh. 
When  a  cold  is  taken,  the  nasal  mucous  membrane  becomes 


Fig .  104. 

inflamed  and  mouth-breathing  resulted.  There  was  a  marked 
arrest  of  development  of  the  jaw.  Because  of  the  small  size  of 
the  jaw,  the  teeth  anterior  to  the  molars  pushed  forward  and 
became  crowded  when  the  molars  erupted.  Upon  the  left  side 
the  second  bicuspid  had  been  removed,  affording  sufficient  room 
for  eruption  of  the  second  molar  on  that  side. 

Case  XV,  Fig.  no.  An  eight  year  old  Canadian.  Height 
of  vault,  .43  of  an  inch.  She  had  always  been  a  mouth-breather. 
She  had  suffered  from  catarrh  for  five  years  previous  to  coming 
under  observation.  Her  general  health  had  improved  since 
removal  to  Chicago,  six  months  previously.  There  was  marked 
arrest  of  development  of  the  superior  maxilla. 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT. 


267 


A  case  at  the  age  of  eight  years  is  of  unusual  interest  in  con- 
nection with  the  principles  advanced  in  this  work.  The  usually 
low  elevation  of  the  vault  was  due  to  lack  of  development.  The 
normal  height  was  reached  at  the  proper  age.  The  temporary 
molars  and  cuspids  upon  the  left  side  and  the  temporary  second 
molar  upon  the  right  side  were  extracted,  just  before  securing 
the  model.  Although  the  permanent  bicuspids  and  cuspids 
upon  the  left  side  were  not  visible  yet  the  appearance  of  the 
alveolar  process  led  to  the  belief  that  their  position  will  be 
normal.  Upon  the  right  side  all  the  teeth  except  the  cuspid 
belong  to  the  permanent  set.     The  cause  and  manner  of  the 


;.Fig.'.105. 


production  of  the  saddle-shaped  arch  upon  this  side  of  the  jaw 
was  shown  in  the  position  assumed  by  the  second  bicuspid  and 
first  permanent  molar.  Upon  removing  the  temporary  molar, 
the  crown  of  the  bicuspid  was  seen  to  be  exactly  in  the  position 
represented.  The  first  permanent  molar  moving  forward  had 
crowded  the  cuspid  into  the  roof  of  the  mouth.  The  V-shaped 
appearance  of  the  incisors  was  due  to  lack  of  room  in  the  jaw  for 
their  normal  eruption. 

Case  XVI,  Fig  iii.  A  thirteen  year  old  Hebrew-American 
girl.  Height  of  vault,  .59  of  an  inch.  There  was  adenoid  growth 
in  the  post-nasal  space.  She  was  unable  to  breathe  through 
the  nose.    The  arrest  of  development  was  very  marked  and  the 


268  IRREGULARITIES    OF    THE    TEETH. 

maxilla  unusually  small.  The  lateral  incisors  had  never  erupted. 
The  cuspids  had  moved  forward  and  taken  their  places.  The 
jaw  was  very  narrow  across  at  the  bicuspids  and  much  contracted 
anteriorly  to  them.     The  jaw  was  of  marked  V-shape. 

Case  XVII,  Fig.  112.  A  thirteen  year  old  American  boy. 
Height  of  vault,  .62  of  an  inch.  He  had  breathed  through  the 
mouth  for  six  years  ere  observation.  There  was  considerable 
arrest  of  development  of  the  bones  of  the  nose.  The  left  nostril 
had  collapsed  and  the  right  nostril  partially.  The  patient  could 
breathe  through  the  left  only  and  with  difificulty.  The  jaw  in  this 
case  was  well  developed.    The  forward  movement  of  the  incisors 


Fig.  106. 

was  due  to  a  local  factor  of  irritation,  produced  by  the  lower 
teeth  striking  against  the  roof  of  the  mouth.  This  caused  a 
deposit  of  bone-cells  at  that  point. 

Case  XVIII,  Fig.  113.  A  fourteen  year  old  American  boy. 
Height  of  vault,  .59  of  an  inch.  He  had  always  breathed  through 
the  mouth.  The  septum  nasi  was  deflected.  There  was  hyper- 
trophy of  the  mucous  membrane.  The  left  nostril  was  closed. 
In  this  case  the  jaw  was  well  developed.  Although  the  teeth 
were  large  there  was  no  marked  deformity.  The  central  incisors 
overlapped  slightly.  The  anterior  teeth  protruded  on  account  of 
the  pushing  forward  of  the  posterior  teeth.  A  side  view  shows 
this  forward  inclination  of  the  teeth. 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT. 


269 


Case  XIX,  Fig.  114.  A  twenty-five  year  old  American  man. 
Height  of  vault,  .62  of  an  ich.  He  had  been  a  mouth-breather 
for  twelve  years.  The  left  nostril  was  entirely  closed,  from  a 
blow  at  the  age  of  thirteen.  The  jaw  was  well  developed.  The 
slight  saddle-shaped  appearance  of  the  right  side  was  due  to 
the  position  of  the  second  molar  had  crowded  the  first  molar 
forward  and  inward.  On  the  left  side  the  first  molar  had  been 
removed.  The  second  molar  had  moved  forward,  partially  fill- 
ing the  space. 

Case  XX,  Fig.  115.    A  sixteen  year  old  American.     Height 


Fig.  107. 

of  vault,  .59  of  an  inch.  Always  has  been  a  mouth-breather. 
There  was  present  a  complete  collapse  of  the  nostrils.  There 
was  a  small  jaw  anterior  to  the  cuspids.  There  was  slight  pro- 
trusion of  the  anterior  teeth  and  alveolar  process.  On  the  left 
side  the  lateral  incisor  had  erupted  slightly  inward  relatively 
to  the  central  incisor  and  cuspid.  There  was  marked  asym- 
metry; the  left  side  was  quite  undeveloped. 

Case  XXI,  Fig.  116.  This  woman  patient  had  always  been 
a  mouth-breather  because  of  the  thickening  of  the  mucous  mem- 
brane of  the  nose.  The  development  of  the  maxilla  had  been 
arrested.     There   was  considerable  protrusion  of  the  anterior 


270 


IRREGULARITIES    OF    THE    TEETH. 


teeth  and  alveolar  process,  from  lack  of  room.  Associated  with 
this  was  interstitial  gingivitis.  The  jaw  was  narrow  and  com- 
pressed in  the  region  of  the  bicuspids.  On  the  right  side  the  first 
first  bicuspid  had  been  extracted  to  afiford  room  for  the  other 
teeth.  The  left  lateral  incisor  was  small.  The  left  bicuspids  were 
situated  within  the  arch,  erupting  in  this  position  because  of 
retention  of  the  temporary  teeth.  This  side  approximated  the 
saddle-shaped  deformity. 

Case  XXII,  Fig.  117.  A  sixteen  year  old  American  boy. 
Height  of  vault,  .50  of  an  inch.  He  had  been  a  mouth-breather 
for  ten   years.     The  anterior  part  of  the  jaw  was  contracted, 


Fig.  108. 

approximating  the  V-shaped  deformity.  There  was  no  irregu- 
larity of  the  teeth. 

Case  XXIII,  Fig.  118.  A  twenty-six  year  old  American 
man.  Height  of  vault,  .75  of  an  inch.  He  had  always  breathed 
through  the  mouth.  There  was  lack  of  harmony  between  the 
size  of  the  jaw.  The  teeth,  in  consequence  of  which  the  anterior 
teeth  had  erupted  irregularly.  The  central  incisors  overlapped 
slightly.  The  approximal  surfaces  of  the  lateral  incisors  were 
internal  to  the  palatine  surfaces  of  the  centrals.  Posterior  to 
the  cuspids  the  dental  arch  was  normal. 

Case  XXIV,  Fig.  119.  A  twelve  year  old  American  girl. 
Height  of  vault,  .53  of  an  inch.  She  has  always  breathed  through 
the  mouth.     Septum  nasi  was  deflected.     The  left  nostril  was 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  271 

closed.  The  anterior  part  of  the  jaw  was  contracted.  In  conse- 
quence of  this  contraction  the  central  incisors  protruded.  The 
lateral  incisors  were  slightly  internal  to  the  centrals,  lack  of 
room  in  the  jaw  preventing  them  from  assuming  their  normal 
position.  The  cuspids  were  erupting.  On  the  left  side  the 
second  temporary  molar  was  present. 

Thirty-six  impressions  of  the  mouths  of  children,  ranging 
from  six  to  twelve  years  (Plates  i  to  6,  see  third  edition),  for  the 
purpose  of  showing  development  of  the  vault.  These  impres- 
sions were  taken  in  modelling  compound  as  the  children  came 
who  were  not  selected  as  regards  conditions  of  themouth.    Two 


Fig.  109. 

sets  of  models  were  prepared,  one  for  the  lithographer  and  the 
other  for  study.  A  sufficient  amount  of  compound  was  used 
so  that  the  surplus  would  extend  backward  and  downward  in 
order  that  the  contour  of  the  soft  palate  could  also  be  secured. 
This  was  accomplished  by  the  patients  placing  the  tongue  against 
the  compound  and  breathing  through  the  nose.  Measurements 
were  first  taken  of  the  models  and  then  they  were  sawed  at  the 
median  line.  One-half  was  placed  upon  paper  and  an  outline 
taken ;  then  the  halves  were  glued  together  and  the  saw  passed 
through  the  model  transversely,  just  anterior  to  the  first  perma- 
nent molar,  then  the  anterior  part  was  outlined,  thus,  in  this 
manner,  the  illustrations  were  taken  accurately.     While  litho- 


272 


IRREGULARITIES    OF    THE    TEETH. 


graph  plates  do  not  give  as  accurate  an  illustration  of  a  model 
as  might  be  desired,  they  are  sufficiently  exact  to  show  relation 
of  the  teeth  to  the  jaw  at  the  period  indicated  on  each  plate. 
These,  together  with  the  antero-posterior  (Plates  i,  3,  5,  7,  9,  11) 


Fig.  no. 

and  lateral  illustrations  (Plates  2,  4,  6,  8,  10,  12),  give  a  very 
good  idea  of  the  progress  of  development  from  the  development 
of  the  first  permanent  molar  through  the  period  of  shedding 
the  temporary  teeth  and  their  places  filled  with  the  second  set. 
The  studies  were  begun  at  the  sixth  year,  since  jaw  deformi- 
ties are  rarely  before  that  period.    The  changes  w'hich  take  place 


Fig.  111. 


in  the  jaws  and  vault  are  usually  noticed  between  the  ages  of 
six  and  twelve,  they  being  dependent  upon  the  time  of  the 
eruption  of  the  permanent  teeth  anterior  to  the  first  permanent 
molars.    There  were  three  models  at  six  years  and  three  at  seven 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT.        273 

years.  The  changes  in  the  vault  are  so  sHght  that  more  would  be 
useless. 

Certain  conditions  in  the  contour  of  the  vault  which  must 
not  be  lost  sight  of,  can  be  easily  studied  in  these  models.  In 
a  general  way  the  vaults  are  quite  low  and  without  character. 

Starting  at  the  median  line  of  the  cross  sections  (Plates  2, 
4,  6,  8,  10,  12),  the  vault  is  quite  narrow  at  the  upper  portion 
and  the  lines  in  either  direction  diverge  until  the  teeth  are 
reached.  The  teeth  also  diverge  outward.  \'ery  few  of  the 
models  contain  bicuspid  teeth  until  the  eleventh  year. 

The  alveolar  proces  is  quite  thick  in  the  sixth  and  seventh 


Fig.  112. 

year  models,  but  lengthens  and  becomes  thinner  as  age  advances. 
The  thickness  iarises  from  the  antrum  being  located  between  the 
inner  and  outer  plate  of  bone,  and  the  alveolar  process  not  only 
contains  the  roots  of  the  temporary  teeth,  but  the  crowns  of  the 
permanent  teeth  as  well. 

The  height  of  vault  is  very  low,  while  there  is  not  always  a 
gradual  advance  from  year  to  year,  yet,  taken  as  a  whole,  from 
the  sixth  to  the  twelfth  year  there  is  quite  an  advance  in  height. 
The  normal  height  of  vault  is  not  reached  until  the  permanent 
teeth  are  all  in  place,  which  w^ould  be  after  the  twelfth  year.  If 
a  Hne  should  be  dropped  from  the  center  of  the  arch,  the  two 
lateral  halves  with  but  few  exceptions  would  be  nearly  alike. 

19 


274 


IRREGULARITIES    OF    THE    TEETH. 


A  slight  ridge  at  the  top  of  the  vault  extends  along  the  median 
line  (Figs.  2,  5,  6,  8,  12,  16,  24,  25,  30,  33,  34  and  36).  A  much 
more  prominent  ridge  may  occur  in  the  mouths  of  children  at 
two  years  (Plate  A).  Upon  either  side  of  the  ridge  there  is  an 
apparent  groove,  sometimes  slight  and  again  quite  marked, 
extending  frequently  only  a  short  distance,  then  again  quite  an 
extent  and  sometimes  the  full  length  of  the  suture.  It  is  not 
always  in  the  same  location,  sometimes  in  the  alveolar  process 
behind  the  incisors,  again  at  the  center  and  often  at  the  posterior 
part  of  the  vault ;  however,  it  is  more  frequently  observed  in  the 
anterior  part  of  the  vault  than  in  the  posterior,  and  sometimes 
more  marked  upon  one  side  than  upon  the  other  and  again  only 


Fig.  113. 

upon  one  side.  In  the  cases  illustrated  by  Figs.  3,  6,  12  and  19, 
and  Plates  i,  2  and  4  (see  third  edition),  the  first  permanent 
molars  have  been  extracted. 

In  the  models  of  the  eleventh  and  twelfth  years,  the  second 
bicuspids  are  seen  coming  down  into  place,  although  many  of 
the  temporary  teeth  are  still  in  the  jaw.  Unlike  the  temporary 
molars,  these  teeth  come  down  vertically.  Although  they  have 
not  fully  erupted,  quite  a  change  has  taken  place  in  the  length 
and  width  of  the  alveolar  process  and  more  character  is  evident 
in  both  the  antero-posterior  and  lateral  curves. 

In  the  antero-posterior  section  (Plates  i,  3,  5,  7,  9  and  11) 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT. 


275 


the  following  changes  are  noticed:  The  temporary  incisors  are 
(Fig.  i)  decayed  down  to  the  gums.  The  permanent  central 
incisors  are  (Figs.  5,  6,  7,  8  and  11)  jnst  making  their  appearance, 
while  in  others  they  are  ab<nit  lialf  way  through  or  are  fully 
developed. 

Just  back  of  tlio  incisors  a  thickening  of  the  alveolar  process 
is  evident:  in  sonic  (|uite  thick,  in  others  tliin.  This  is  due  to  the 
relation  of  the  temporary  incisors  to  the  permanent  ones.  If 
the  temporary  tootii  remain  in  the  jaw  until  the  permanent  one 
comes  nearly  through,  the  alveolar  process  is  much  thicker  than 
if  the  temporary  tooth  be  removed  earlier.     It  is  the  foundation 


Fig.  114. 

upon  which  the  long,  thin  alveolar  process  builds  when  the 
permanent  teeth  are  in  place.  By  following  the  line  backward, 
very  little  character  is  noticed  in  the  curves.  As  the  child  grows 
older  the  evolution  of  development  becomes  more  pronounced. 
Deviation  in  the  curves  results  in  varied  ossification  of  the 
suture.  Sometimes  the  ossification  is  uniform  throughout,  in 
which  case  the  line  will  be  uniform  and  graceful  (Figs,  i,  2,  3, 
7,  9,  10,  II,  15,  16,  17  and  21).  If  the  ossification  be  irregular, 
then  the  lines  become  wavy  and  irregular  (Figs.  4,  5,  6,  8,  12, 
13,  14,  18,  19  and  20). 

The  soft  palate  is  very  accurately  illustrated  in  relation  to 


276 


IRREGULARITIES    OF    THE    TEETH. 


the  hard  palate.  The  older  the  patient  grows  the  longer  the 
antero-posterior  line  becomes.  This  is  to  be  expected,  since 
development  of  the  jaw  is  posteriorly  direction.  Shape  and 
inclination  of  the  soft  palate  depend  upon  the  distance  between 
the  posterior  surface  of  the  hard  palate  and  the  forces. 

In  the  models  (Plate  i,  see  third  edition,  at  six  and  seven 
years)  the  six  year  molars  are  in  place  and  all  the  temporary 
ones  (except  in  Figs.  3  and  6,  where  the  temporary  incisors  have 
all  been  removed) ;  the  left  central  (Fig.  6)  is  coming  into 
position.   As  far  as  contour  of  the  teeth  is  concerned,  it  is  normal. 


Fig.  115. 


At  eight  years  (Plate  2,  see  third  edition)  the  first  permanent 
molars  and  central  incisors  have  erupted  in  all  but  one  of  the 
cases  (Fig.  12),  where  the  first  permanent  molars  have  been 
extracted.  None  of  the  other  permanent  teeth  have  yet  made 
their  appearance.  In  this  plate  a  change  is  seen  taking  place 
in  the  shape  of  the  vault.  The  V  arch  is  beginning  to  develop 
(Figs.  7  and  9),  and  in  the  semi-saddle  (Fig.  11)  local  irregu- 
larities of  the  teeth  are  observed  (Figs.  8  and  19). 

At  nine  years  (Plate  iii,  see  third  edition)  deformities  of  the 
jaws  are  still  more  marked.  A  semi-saddle  is  nicely  outlined 
(Fig.   13),  a  V-shaped  arch  is  noticed  (Figs.   14,   15  and  16), 


DEVELOPMENTAI,    NEUROSES   OF    THE    VAULT. 


277 


while  in  others  the  permanent  teeth  are  not  far  enough  advanced 
to  tell  what  position  they  will  occupy  (Figs.  17  and  18). 

At  ten  years  (Plate  4,  see  third  edition)  the  teeth  are  little 


Fig.  116. 


further  advanced  than  at  nine  years.  The  bicuspids  are  just 
pushing  their  way  through  and  the  jaw  seems  to  be  taking  on 
character.  In  one  case  the  central  incisors  are  crowding  their 
way  to  the  right,  producing  a  marked  deformity  of  the  jaw.     In 


Fig.  117. 


another  case  (Fig.  20)  the  incisors  are  crowding  to  the  right  and 
the  left  cuspid  just  coming  through  the  gums,  producing  a  semi- 
V-shaped  (Fig.  19)  arch.    The  temporary  teeth  in  another  case 


278 


IRREGULARITIES    OF    THE    TEETH. 


are  shed  (Fig.  21),  and  the  bicuspids  first  coming  through  The 
permanent  teeth  are  not  far  enough  advanced  to  decide  exactly 
what  deformity  will  be  produced.  From  lapping  of  the  central 
incisors,  and  eruption  of  both  bicuspids  before  the  cuspids,  it 
is  safe  to  say  that  a  V-shaped  arch  will  occur.  The  permanent 
teeth  (Figs.  22,  23  and  24)  are  not  far  enough  along  to  judge 
what  the  results  will  be. 

At  eleven  years  (Plate  5,  see  third  edition)  the  deformities 
are  still  more  easily  traced.  In  one  case  (Fig.  25)  a  local  irregu- 
larity— a  crowding  inwards  of  the  right  central  incisors — are  due 
to  want  of  room,  has  been  produced  by  the  forward  movement 


Fig.  118. 

of  all  the  teeth  on  the  right  side.  \'  and  saddle  arches  are  well 
illustrated  (Figs.  28,  29  and  30).  Arrest  of  development  of  the 
maxillary  bones  has  occurred  (Fig.  28),  and  a  marked  \^  arch 
will  result.  This  model  is  from  the  model  of  a  boy  seventeen 
years  old.  His  body  became  arrested  in  development  at  nine 
years  of  age  by  an  eruptive  fever. 

At  twelve  years  (Plate  6,  see  third  edition)  the  temporary  teeth 
are  yet  noticeable  in  many  of  these  illustrations.  It  is  easy, 
however,  to  outline  the  forms  of  irregularities  that  will  be  pro- 
duced when  all  the  permanent  teeth  are  in  place. 

The  date  and  the  character  of  the  vault  deformities  that  will 


DEVELOPMKNTAr,  NEUROSP:S  OF  THK  VAULT, 


279 


be  produced  when  all  the  permanent  teeth  are  in  place,  namely, 
between  the  sixth  and  twelfth  year,  or  at  the  time  of  the  develop- 
ment of  the  permanent  teeth,  are  shown  as  well  as  the  fact  that 
vault  deformity  will  depend  upon  the  manner  in  which  the  teeth 
came  into  the  jaw  and  whether  there  will  be  a  V  or  saddle- 
shaped  arch  with  their  modifications,  partial  V  or  saddle,  semi-V 
or  saddle. 

The  shape  of  the  vault  is  also  changed  by  local  irregularities 
of  the  teeth.  Here  any  tooth  may  stand  inside  or  outside  the 
dental  arch  and  the  vault  will  conform  to  the  deformity. 

The  deformity  of  the  vault  is  not  observed  until  at  or  about 


FiR.  119. 

the  sixth  year,  or  the  time  of  the  eruption  of  the  permanent 
teeth.  The  ossification  of  the  suture,  uniting  the  maxillary  bones 
at  the  median  line  takes  place  at  different  intervals — sometimes 
as  early  as  the  eighth  week  of  intra-uterine  life  and  as  late  as  the 
sixteenth. 

Excessive  development  of  the  suture  may  occur  as  early  as 
the  second,  and  as  late  as  the  thirty-sixth  year.  This  excessive 
development  takes  different  shapes  and  forms ;  228  Peruvian 
skulls,  240  Stone  Grave  skulls  and  twenty-one  Mound-Builders' 
skulls,  sixteen  Peruvians,  thirty-nine  Stone  Grave  and  one 
Mound-Builder's  (all  of  which  had  large,  well-developed  jaws, 
normal  in  shape)  had  a  rope-like  projection  extending  the  entire 


280  IRREGULARITIES    OF    THE    TEETH. 

length  of  the  suture.  This  development  was  unlike  the  excessive 
development  of  modern  skulls.  It  had  the  appearance  of  having 
been  first  made  and  then  glued  upon  the  suture  (Fig.  120,  No.  i). 

The  deformity  of  the  suture  (Nos.  2,  3,  4,  5  and  6)  may  vary 
in  proportion  to  the  width  of  the  arch,  in  the  narow  arch  the 
suture  is  low  or  thick,  while  in  the  normal  arch  it  is  flat.  The 
grooves  of  either  side  of  the  suture  are  not  uniform,  one  side 
being  deeper  than  the  other. 

It  has  been  claimed  that  these  grooves  are  due  to  ossifica- 
tion of  the  vomer,  producing  rigidity  of  the  suture  and  the  bone 
upon  either  side  is  afterward  carried  up. 

According  to  Clouston,  "Those  palates  where  the  deformity 
consisted  in  a  ridge  down  the  center  antero-posteriorly,  seemed 
to  show  that  in  them  the  deformity  took  place  at  a  later  period 
than  in  the  other  deformed  .palates.  When  the  nasal  septum 
was  getting  stronger  and  kept  the  center  of  the  palate  down, 
while  on  each  side  of  it  the  palate  was  drawn  up  making  two 
vaults  side  by  side,  instead  of  one."  Six  models  are  shown 
(Plate  A),  ranging  from  two  to  six  years.  At  two  years  there  is 
(Fig.  I  and  2)  a  ridge  extending  from  a  line  drawn  across  the 
vault  at  the  cuspids,  through  the  entire  length  of  the  jaw.  This 
may  begin  in  the  center  of  the  vault  at  a  line  drawn  across  the 
first  temporary  molar."'  At  three  years  of  age  (Fig.  3)  there  may 
be  a  slight  ridge  just  back  of  the  incisors,  extending  only  a 
short  distance,  when  the  center  of  the  vault  is  perfectly  flat,  and 
the  ridge  begins  again  in  the  posterior  part  of  the  vault.  At 
four  years  (Fig.  4)  the  ridge  may  start  at  a  line  drawn  across  the 
vault  at  the  first  molar  and  extending  the  entire  length  of  the 
suture.  At  five  years  (Fig.  5)  a  broad  ridge  may  extend  the 
entire  length  of  the  vault.  At  six  years  (Fig.  6)  a  very  narrow 
ridge  may  extend  the  entire  length  of  the  vault. 

As  the  vault  ossifies  as  early  as  the  first  or  second  year,  and 
as  the  ridge  is  also  found  as  early  as  the  second  year,  the  vomer 

■'^  I  have  a  number  of  these  models  showing  the  ridge  at  thesecondyear 
and  observed  many  more  in  practice.  Since  the  two  halves  of  the  maxil- 
lary bones  do  not  ossify  till  the  eighth  week  of  foetal  life,  it  can  readily  be 
seen  that  where  ossification  is  not  complete  these  ridges  would  form  when 
the  child  begins  to  masticate  its  food. 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT,  281 


Deformed  Vaulk. 


Fig-  120. 


282  IRREGULARITIES    OF    THE    TEETH. 

not  ossifying  until  later  in  life,  Clouston's  theory  does  not 
explain  the  facts.  The  ridge  takes  so  many  different  shapes 
that  when  a  number  of  models  containing  it  are  examined  the 
theory  that  the  sides  of  the  arch  are  drawn  or  pushed  up  appears 
more  and  more  untenable.  Thus  come  models  (Figs.  7  and  8, 
Plate  B)  showing  vaults  similar  to  No.  2,  Fig.  120,  except  the 
grooves  are  deep  and  sharp.  In  Fig.  7  it  extends  from  just  back 
of  the  incisors  to  opposite  the  second  molars,  where  the  arch 
becomes  perfectly  smooth  throughout  the  balance  of  the  hard 
palate.  Fig.  8  it  commences  at  the  same  point  and  stops  opposite 
the  first  permanent  molar.  These  models  demonstrate  the  fal- 
lacy of  this  tlieory.  since  nothing  could  force  the  deep  grooves 
in  the  anterior  alveolar  process,  as  suggested  by  many  authors, 
since  the  vomer  extends  through  and  beyond  the  anterior  surface 
of  the  anterior  alveolar  process  to  form  the  nasal  spine.  If 
such  a  thing  were  possible,  the  posterior  part  of  the  vaults,  which 
would  easily  yield  to  force  would  be  affected.  This  is  not  the 
case.  The  ridge  extends  to  the  second  molar,  or  as  far  as  the 
grooves.  One  of  the  jaws  is  very  small  and  contracted  with 
slight  hypertrophy  extending  all  around  the  inner  surface,  giving 
the  sharp  appearance  to  the  grooves  ;  the  other  is  a  little  larger, 
has  not  hypertrophy,  hence  the  groove  upon  either  side  of  the 
suture  is  not  so  narrow,  although  fully  as  deep.  In  Figs.  9  and 
10,  Plate  C  are  well  developed  jaws  with  very  broad  ridges.  In 
Fig.  9  the  ridge  commences  about  opposite  the  first  bicuspid 
and  extends  back  as  far  as  the  second  molar  tooth.  In  Fig.  10 
the  ridge  extends  from  the  alveolar  process  just  back  of  the 
incisor  to  the  second  molar;  both  are  about  the  same  width. 
The  grooves  upon  either  side  are  very  shallow  and  about  the 
same  depth  of  ridge.  These  are  similar  to  those  of  Nos.  4.  5 
and  6,  Fig.  120.  In  Fig.  11.  Plate  D,  is  seen  a  very  small  jaw 
with  a  marked  ridge  commencing  in  the  alveolar  process  back  of 
the  incisors  and  extending  as  far  as  the  second  molars ;  the 
grooves  upon  either  side  are  very  deep  and  sharp.  This  is  due 
to  a  small  jaw  and  hypertrophy  of  the  alveolar  process.  There 
is  occasionally  a  groove  in  the  center  of  the  vault  running  the 
entire  length  of  the  suture  in  place  of  the  ridge,  as  Fig.  12, 
Plate    D.      This  is  du?  to  arrest  of  development  of  the  suture 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  283 

PLATE  A. 


284  IRREGULARITIES    OF    THE    TEETH. 

and  hypertrophy  of  the  palate  bones  and  mucous  membrane 
upon  either  side  of  the  suture.  This  groove  is  sometimes  shal- 
low, again  deeper,  sometimes  broad  and  again  narrower,  this 
depending  upon  the  extent  of  the  hypertrophy. 
,  The  two  sides  of  the  contracted  arches  are  not  uniform. 
This  is  due  to  the  location  of  the  teeth  in  the  alveolar  process 
more  in  upon  one  side  than  upon  the  other,  carrying  the  alveolar 
process  with  it.  The  sides  of  the  palate  are  not  carried  up  since 
there  is  no  force  to  move  them.  These  deep  grooves  may  be 
situated  entirely  in  the  anterior  alveolar  process ;  sometimes 
entirely  on  one  side ;  sometimes  in  the  center  of  the  vault  in  the 
anterio-posterior  direction,  and  again  in  the  posterior  part  of  the 
vault. 

The  location  of  these  grooves,  especially  those  in  the  alveolar 
process,  and  the  fact  that  sometimes  they  extend  only  .25  to  .50 
of  an  inch,  renders  such  a  theory  untenable.  If  the  sides  were 
carried  up,  owing  to  the  very  thin  bone,  a  like  projection  would 
extend  into  the  floor  of  the  nose.  I  have  examined  1,367  skulls 
with  this  deformity  and  I  have  yet  to  find  the  first  instance  of 
this  projection.  In  every  case  the  floor  of  the  nose  and  com- 
mencement of  the  septum  were  smooth  and  evenly  developed 
throughout  its  entire  length.  How.  then,  are  these  deformities 
to  be  accounted  for?  These  projections  are  developed  as  early 
as  the  second  year,  and  as  late  as  the  thiry-sixth  year.  They 
are,  hence,  the  result  of  excessive  development  of  the  suture, 
due  to  irritation  set  up  at  the  time  of  ossification,  by  mastica- 
tion. The  lower  jaw  develops  laterally  faster  than  the  upper, 
thus  crowding  the  superior  maxillary  bones  apart.  This  occurs 
in  a  large  number  of  patients  of  which  the  following  is  a  type. 

A  lady,  thirty-six  years  of  age.  who  has  been  under  my  care 
for  the  past  fifteen  years,  has  a  space  between  the  central  incisors 
of  .50  of  an  inch.  No  space  was  observed  until  she  arrived 
at  the  age  of  twenty  years.  The  teeth  filled  the  arch  and  all 
antagonized.  The  lower  jaw  continued  to  delevop  and  the  act 
of  mastication  carried  the  superior  maxillary  bone  laterally 
widening  the  suture,  the  space  filling  in  and  producing  quite 
a  ridge  (Fig.  120,  Nos.  4,  5  and  6).  The  depth  of  the  ridge 
depends  upon  the  amount  of  irritation.  The  height  of  the  groove 


DEVELOPMENTAL    NEUROSES    OF    THE    VAULT.  285 


PLATE  B. 


286  IRREGULARITIES    OF    THE    TEETH. 


PLATE   C. 


DEVELOPMENTAL  NEUROSES  OF  THE  VAULT.        287 

on  either  side  depends  upon  the  depth  of  the  ridge.  When  there 
are  grooves  upon  cither  side  the  jaw  is  ahvays  contracted,  the 
alveolar  process  being  nearer  the  center  of  the  vault.  This, 
together  with  the  ridges,  produces  the  groove.  Were  it  not 
for  excessive  development  of  the  median  suture  and  contracted 
arch,  the  vault  would  take  the  shape  of  the  dotted  lines  and 
would  be  of  normal  development. 

Deformed  vaults  are  due  (i)  to  an  irregularity  in  the  arrange- 
ment of  the  dental  arch,  (2)  hypertrophy  of  the  alveolar  process 
and  maxillary  bones,  and  (3)  to  excessive  development  of  the 
palatine  suture.  Irregularities  of  the  dental  arch  are  the  result 
of  (i)  neurosis  of  development,  producing  arrest  of  develop- 
ment of  the  maxillary  bone ;  (2)  local  causes  accidental  or  other- 
wise. Those  produced  by  an  arrest  of  development  take  typical 
forms,  classified  under  the  heads  of  X,  partial  \',  semi-Y,  saddle, 
partial  saddle  and  semi-saddle.  The  irregularities  of  the  teeth, 
produced  by  local  causes,  do  not  take  typical  forms,  they  are 
as  numerous  as  the  number  of  cases. 

Hypertrophy  of  the  alveolar  process  may  afifect  the  whole 
dental  arch,  or  ma}-  attack  one  particular  locality  in  which  only 
one,  two  or  three  teeth  may  be  involved.  The  shape  of  the 
vault  in  such  cases  depends  entirely  upon  the  extent  of  the 
hypertrophy,  but  does  not  take  the  typical  form.  The  position, 
occupied  by  the  teeth  in  the  dental  arch,  and  the  manner  of  their 
formation  should  be  studied  under  their  respective  heads.  The 
deformed  vault  should  be  compared  with  the  normal  vault.  For 
this  purpose  I  secured  models  from  dental  practitioners  in  Chi- 
cago, consisting  of  six  V-shaped  (Plates  29  and  30),  six  semi-V 
(Plates"  31  and  32),  six  saddle  (Plates  33  and  34),  and  six  semi- 
saddle-shaped  (Plates  35  and  36).  These  were  prepared  in  the 
same  manner  as  the  other  models. 

The  direction  of  the  teeth  in  a  normal  jaw  are  nearly  perpen- 
dicular, while  those  in  the  V-shaped  vault  are  at  an  angle  of 
45  degrees.  This  is  due  to  the  forward  movement  of  the  incisor 
teeth.  Just  back  of  the  incisor  teeth  there  is  a  prominent  ridge 
of  alveolar  process  (noticed  in  the  normal  jaw),  is  due  to  con- 
traction of  the  vault  in  the  anterior  portion,  producing  thicken- 
ing of  the  alveolar  process.     In  other  respects  the  vault  does 


288  '  IRREGULARITIES    OF    THE    TEETH. 


PLATE   D. 


DKVKt.OPMKNl'AI.    NEUROSES    OK    THE    VAULT.  289 

not  differ  from  the  normal  palates.  The  same  general  rule  holds 
good  in  the  semi-V  vault,  except  that  the  teeth  do  not  stand 
at  such  an  angle.  This  is  due  to  the  fact  that  frequently  but 
one  incisor  protrudes,  hence,  one  incisor  only  extends,  while 
the  other  is  perpendicular.  The  position  of  the  normal  tooth 
may  be  on  the  side  of  the  model  reproduced  in  this  illustra- 
tion. In  the  illustrations  showing  a  cross  section  of  the  vault, 
the  vaults  are  usually  much  narrower  than  in  the  normal.  The 
two  sides  of  the  vault  are  not  in  harmony.  These  illustrations 
were  very  accurately  made,  so  that  by  placing  a  rule  at  the  center 
of  the  upper  and  lower  arches,  and  drawing  a  line  from  one  to 
the  other,  the  two  sides  of  the  vault  can  be  easily  studied.  The 
more  contracted  the  jaw,  the  higher  the  vault  and  more  irregular 
the  sides.  In  the  saddle  and  semi-saddle  antero-posterior  illus- 
trations the  teeth  stand  perpendicularly,  hence,  do  not  protrude. 
The  ridge,  posterior  to  the  incisors  is  not  so  thick  or  prominent. 
The  lateral  illustrations  do  not  show  the  pinched  condition  at 
the  upper  part  of  the  vault  that  is  noticed  in  the  V-shaped 
vaults.  This  is  due  to  the  fact  that  the  contr-action  is  not  in  the 
anterior  part  of  the  mouth,  but  at  the  bicuspid  region,  while 
the  bicuspids  are  carried  in.  The  top  of  the  vault  is  rarely  ever 
affected.  Occasionally  alveolar  process  hypertrophy  is  so  exten- 
sive that  the  teeth  are  carried  laterally  toward  the  median  line, 
the  vault  is  very  much  narrower  and  sometimes  almost  closed. 
Local  irregularities  of  the  teeth  may  affect  only  the  margins 
of  the  vaults  and  not  the  vault  proper,  since  but  few  teeth  are 
ever  involved.  The  remainder  of  the  dental  arch,  being,  as  a 
rule,  normal,  the  vault  proper  is  retained  in  its  natural  shape. 


20 


CHAPTER   XXIV. 


DEVELOPMENTAL  NEUROSES  OF  THE  PALATE. 

As  soon  as  the  external  nares  are  separated  from  the  mouth 
a  partition  forms  between  the  nasal  pits  and  the  mouth.  This 
partition  in  which  the  intermaxillary  bone  is  differentiated  later 
is  supplemented  by  another  partition  (the  true  palate),  which 
shuts  off  the  upper  part  of  the  oral  cavity  from  the  lower,  thus 
adding  the  upper  part  to  the  nasal  chambers.  The  palate  is  a 
secondary  structure  which  divides  the  mouth  into  an  upper 
respiratory  passage  and  a  lower  lingual  or  digestive  passage. 
The  palate  arises  as  two  shelf-like  growths  on  the  inner  side  of 
each  maxillary  process.  It  is  completed  by  union  of  the  two 
shelves  in  the  median  line.  The  shelves  arch  so  as  to  descend 
a  certain  distance  into  the  pharynx,  but  in  the  pharynx  their 
growth  is  arrested,  though  they  may  be  still  recognized  in  the 
adult.  In  the  region  of  the  tongue  which  includes  more  than 
the  primitive  oral  cavity,  the  palate  shelves  continue  growing. 

At  first  they  project  obliquely  downward  toward  the  floor 
of  the  mouth  and  the  tongue  rises  high  between  them  and  appears 
in  sections  which  pass  through  the  internal  nares  to  be  about  to 
join  the  internasal  septum.  As  the  lower  jaw  grows  the  floor 
of  the  mouth  is  lowered  and  the  tongue  is  thereby  brought 
further  away  from  the  internasal  septum.  At  the  same  time 
the  palate  shelves  take  a  more  horizontal  position  and  pass 
toward  one  another  above  the  tongue  and  below  the  nasal  sep- 
tum and  meet  in  the  middle  line  where  they  unite.  From  their 
original  position  the  shelves  necessarily  meet  in  front  (toward 
the  lips)  first  and  then  unite  behind  (toward  the  pharynx)  later. 
In  the  human  embryo  the  union  begins  at  eight  weeks  and  at 
nine  weeks  is  completed  for  the  region  of  the  future  hard  palate, 
and  by  eleven  weeks  is  usually  completed  for  the  soft  palate 
also.  The  palate  shelves  extend  back  across  the  second  and  third 
branchial  arches ;  by  the  migration  of  the  first  gill  pouch  or  in 
other  words  of  the  Eustachian  tube,  the  Eustachian  opening 

290 


DEVELOPMENTAL    NEUROSES    OF    THE    PALATE.  201 

comes  to  lie  above  the  palate  (uvula),  while  the  second  cleft 
remains  lower  down  and  lies  below  the  palate  as  the  anlage  of 
the  tonsil.  The  uvula  appears  during  the  latter  half  of  the  third 
month  as  a  projection  of  the  border  of  the  soft  palate.  Soon 
after  the  two  palatal  shelves  have  united  with  one  another  the 
nasal  septum  unites  with  the  palate  also,  and  thereby  the  per- 
manent or  adult  relations  of  the  cavities  are  estabHshed.^ 

According  to  Bcaunis  and  Bouchard  the  related  development 
of  the  surrounding  parts  occurs  as  follows :  "Beginning  of  third 
week — first  pharyngeal  arch ;  buccal  depression.  End  of  third 
week,  coalescence  of  the  inferior  maxillary  protuberances ;  form- 
ation of  the  three  last  pharyngeal  arches.  Fourth  week — olfactory 
fossae.  Fifth  week — ossification  of  lower  jaw.  Sixth  \veek — 
the  pharyngeal  clefts  disappear;  the  tongue,  the  larynx  and 
germs  of  teeth.  Seventh  week — points  of  ossification  of  inter- 
maxillary bone ;  palate  and  upper  jaw  (its  first  four  points). 
Eighth  week — the  two  halves  of  the  bony  palate  unite.  Ninth 
week — osseous  nuclei  of  vomer  and  malar  bone ;  the  union  of  the 
hard  palate  is  completed.  Third  month — points  of  ossification 
for  the  sphenoid  and  nasal  bones ;  squamous  portion  of  temporal ; 
orbital  center  of  superior  maxillary  bone;  commencement  of 
formation  of  maxillary  sinus ;  epiglottis.  Fifth  month — osseous 
points  of  lateral  masses  of  ethmoid;  ossification  of  germs  of 
teeth ;  appearance  of  germs  of  permanent  teeth." 

It  will  be  obvious  that  any  maternal  factor  (whether  arising 
during  a  particular  pregnancy  or  hereditary)  may  so  check  the 
development  of  the  palate  as  to  produce  the  various  types  of 
deficiency  which  are  observed  by  surgeons.^  Cleft  palates  are 
comparatively  rare  in  proportion  to  other  forms  of  nutritive 
degeneracy.  As  just  pointed  out  palatal  embryology  casts  a 
certain  hght  on  the  etiology.  Since  most  cases  of  cleft  palate 
occur  in  defective  individuals,  and  since  cleft  palate  predisposes 
to  death  by  infectious  diseases  whose  local  manifestations  are 
in  the  mouth  and  throat,  defectives  in  whom  cleft  palate  most 
occurs  are  liable  to  die  before  the  completion  of  their  fifth  year. 

Cleft  palate  was  much  discussed  by  early  writers.     Early  in 

1  Minot  Embryology. 

2  Keen's  American  System  of  Surgery,  page  639. 


292  IRREGULARITIES    OF    THE    TEETH. 

the  nineteenth  century  Tiedemanir  noticed  in  certain  cases  of  cleft 
palate  that  the  olfactory  nerve  was  absent  or  abnormal.  He  con- 
cluded therefrom  the  deformity  was  resultant  upon  atrophy  of 
nervous  origin  of  the  olfactory  organ.  This  theory,  however, 
failed  to  meet  much  acceptance.  M.  J.  Weber,  after  a  careful 
analysis  of  all  accessible  cases,  failed  to  find  one  in  which  the 
olfactor}^  nerve  was  absent.  The  coincidence  of  cleft  palate 
and  olfactory  nerve  atrophy  discovered  by  Tiedemann  probably 
resulted  from  the  same  central  nerv^ous  maldevelopment.  They 
bore  no  casual  relation  to  each  other. 

The  failure  from  various  causes  of  the  ultimate  coalescence 
of  the  structures  described  by  Minot  leads  to  certain  deformities 
the  chief  of  which  are  cleft  palate  and  harelip.  Cleft  palate,  accord- 
ing to  Bland  Sutton,'*  has  been  known  to  affect  several  members 
of  the  same  family  and  to  occur  in  the  offspring  of  the  affected 
members.  There  are  instances  of  the  transmission  of  this 
deformity  from  an  affected  pug-bitch  to  her  offspring.  If  it  were 
possible  to  practice  selective  breeding  in  man  as  in  dogs,  a  race 
of  men  with  hare-lips  and  cleft  palates  could  be  produced. 

Engle  refers  cleft  palate  to  excessive  development  of  the 
anterior  portion  of  the  brain  and  skull,  such  as  produces  hernia 
cerebri,  ventricular  atrophy  or  excessive  anterior  cerebral  lobe 
development.  This  mixed  patho-teratologic  theory  is  not  war- 
ranted by  either  embryology  or  clinical  observation.  The  narrow 
and  broad  foreheads  are  alike  affected. 

Langdon  Down,  who  has  found  a  constant  relation  between 
brain  deformity,  cleft  palate  and  deformed  vaults,  states :  "The 
cause  of  the  frequent  excessive  vaulting  of  the  palate  is  not  quite 
clear.  It  may  possibly  arise,  as  has  been  suggested,  from  sphen- 
oid arrest  of  development  or  vomer  defects  in  development." 
It  has  been  plausibly  shown  that  contracted  high  vault  is  not 
due  to  these  conditions,  and  there  can  be  no  relation  between 
contracted  vaults  and  cleft  palates.  The  cleft  occurs  before  the 
tenth  week  of  foetal  life,  while  the  contracted  vault  does  not 
appear  until  after  the  sixth  year.    The  claim  was  made  by  Wal- 

3  Zeitschrift  f.  Phys.,  Band  i,  Heft  i,  1844,  p.  71- 
*  Evolution  and  Disease,  page  189. 


DEVELOPMENTAL    NEUROSES    OF    THE    PALATE.  293 

ther'^  and  Langenbuch^  that  cleft  palate  was  becoming  more 
frequent  during  the  present  century.  This  opinion  was  sup- 
ported by  Oakley  Coles'^  on  the  ground  that  palatal  vault 
deformities  are  more  frequent  and  that  a  relationship  existed 
between  these  and  cleft  palate.  That  the  relation  between  a  high 
state  of  civilization  and  a  high  proportion  of  palatal  deformities 
is  something  more  than  a  mere  matter  of  coincidence.  Coles, 
in  dealing  with  the  influences  of  civilization,  ignores  all  but  its 
supposed  degenerative  influence.  Under  civilization  the  defec- 
tive classes  are  preserved.  Furthermore,  this  preservation 
extends  particularly  to  those  under  five  years  of  age  who  would 
be  destroyed  under  primitive  conditions. 

Early  literature  on  this  subject  is  admittedly  meager.  Early 
teratologists  discussed  the  gross  rather  than  the  minute  details, 
and  registration  of  cleft  palates  was  neglected  in  common  with 
brain,  renal,  hepatic  and  cardiac  teratology. 

Cleft  palate  may  divided  into  two  classes — congenital  and 
acquired.  Congenital  cleft  palate  is  meant  existing  at  birth. 
Acquired  cleft  palate  is  the  result  of  disease,  inherited  or 
acquired,  but  affecting  the  part  after  birth.  Better  acquaintance 
with  disease  etiology  and  its  effects  upon  the  hard  palate 
shows  causes  of  congenital  lesions  and  effects  of  acquired  disease 
upon  the  tissues  to  be  at  least  allied. 

Congenital  cleft  palate  is  divisible  into  two  kinds — complete 
and  partial ;  complete,  when  the  fissure  extends  the  entire  length 
from  the  uvula  to  and  including  the  anterior  alveolar  process 
and  even  the  lips ;  partial,  when  only  a  small  part  of  the  structure 
is  involved.  Thus  the  cleft  may  extend  through  the  anterior 
alveolar  process  involving  only  the  incisive  bones,  which  is  very 
rare ;  when  present,  single  or  double  harelip  almost  invariably 
co-exists.  Cases  occur  where  a  small  portion  of  the  anterior 
alveolar  process  and  jaw  was  involved  with  one  or  two  teeth. 
The  hard  palate  only  may  be  involved  to  the  extent  of  a  small 
fissure,  or  the  whole  palate  may  be  wanting.  The  soft  palate 
only  may  contain  the  cleft  or  simply  the  uvula.     Cases  are  on 

5  Graefe  and  Walther's  Zeitschrift,  Band  21,  Heft  2,  1834,  page  175. 
«  Neue  Bibliothek  f.  die  Chir.,  Band  4,  Heft  3,  page  492. 
^  Coles :    Deformities  of  the  Mouth. 


294  IRREGULARITIES    OF    THE    TEETH. 

record   in   which    the   non-development   of   the    intermaxillary 
bones  produces  fissures  in  the  lip. 

A  priori  cleft  palate  would  seem  to  be  a  direct  expression  of 
heredity.  This  view  is  taken  by  Bland  Sutton^  from  actual 
observation.  According  to  Oakley  Coles,''  "the  antecedent 
which  strikes  one  a  priori,  as  being  likely  to  play  the  most 
important  part  in  the  production  of  congenital  deformities,  is 
that  of  hereditary  influence.  But  though  it  will  be  evident  from 
the  facts  which  I  shall  presently  adduce  that  the  direct  influence 
of  heredity  in  the  production  of  cleft  palate  is  marked  and  unde- 
niable, no  sufficient  statistics  have  as  yet  been  brought  forward  to 
show  that  the  actual  presence  of  the  deformity  in  the  parent  has 
any  direct  predisposing  influence  in  the  child.  In  other  words, 
though  the  defective  conditions  which  precede  and  accompany 
the  phenomenon  of  cleft  palate  are  almost  certainly  to  be  referred 
to  parental  influence  it  is  extremely  doubtful  whether  cleft 
palate  is  in  itself  transmissible."  Demarquay,  Roux,  Trelat, 
FolHn  and  Duplay  are  inclined  to  an  opposite  belief  and  their 
conclusion  is  supported  by  the  evidence  in  connection  with  the 
analogous  deformity  of  harelip.  Still,  unless  accurate  records 
of  ancestry  could  be  obtained  for  three  or  four  degrees  of 
removal,  it  would  be  premature  to  make  any  positive  assertion 
on  the  point.  However,  it  may  be  confidently  stated  the  deform- 
ity is  not  usually  produced  from  impressions  received  by  the 
mother  during  pregnancy.  In  most  of  the  cases  which  have 
come  immediately  under  my  notice,  where  one  of  the  parents 
had  a  cleft  palate,  all  the  children  have  been  born  perfectly 
developed,  even  though  dread  of  transmitting  the  deformity  was 
always  present  in  the  mind  of  the  mother.  In  one  case,  curiously 
enough,  there  are  three  members  of  one  family  with  cleft  palate, 
one  seventeen  years  of  age,  the  other  thirty  and  the  third  thirty- 
five  ;  the  first  and  last  are  ladies,  the  other  a  gentleman  who  is 
married  and  has  -a  family  without  any  trace  of  the  father's 
deformity.  In  these  cases  no  instance  of  cleft  palate  could  be 
found  either  among  the  ancestors  or  the  collateral  branches  of 
the  family. 

8  Op.  Cit. 

°  Deformities  of  the  Mouth. 


DEVELOPMENTAL    NEUROSES    OF    THE    PALATE.  295 

In  another  family,  I  have  obtained  the  following  remarkable 
history:  G.  H.  C,  born  1853 ;  perfect.  L.  C,  born  1855 ;  single 
harelip  and  cleft  palate.  J.  F.  C,  born  1856;  perfect.  F.  W.  C, 
born  i860;  double  harelip  and  cleft  palate.  H.  E.  C,  born  1863 ; 
perfect.     The  paternal  grandmother  also  had  cleft  palate. 

Knecht^^  found  five  per  cent  of  1,200  criminals  examined  to 
have  cleft  palates  and  fourteen  per  cent  of  the  prostitutes  exam- 
ined by  Pauline  Tarnovi^skyi^had  cleft  palates.  Langdon  Down, 
among  congenital  idiots,  found  only  a  half  per  ceat  of  cleft 
palates.  Grenser  only  found  nine  cases  in  14,466  children,  or  one 
in  1,607.  I  examined  1,977  feeble-minded  children  without 
finding  a  single  case.  In  207  blind,  but  one  case  was  observed. 
In  1,935  deaf  mutes  two  cases,  or  about  one  in  1,000.  The 
percentage  among  the  defective  classes  is  undoubtedly  much 
larger  than  among  normal  individuals,  but  early  deaths  explain 
the  small  numbers. 

Bland  Sutton's  experiments  with  dogs  indicate  not  only  the 
presence  of  this  deformity  among  animals,  but  the  fact  that 
it  is  transmitted.  The  influence  of  heredity  is  shown  by  the 
statistics  of  zoologic  gardens.  A  keeper  of  the  Zoologic  Gar- 
dens in  Philadelphia  observed  cleft  palates  in  the  mouths  of 
lion  cubs  born  in  the  gardens.  Cleft  palates  were  also  observed 
in  a  number  of  pups  born  in  Buffalo. 

Ogle  found  that  ninety-nine  per  cent  of  the  lion  cubs  born 
in  the  London  Zoologic  Gardens  had  cleft  palates.  This  he 
ascribes  to  the  artificial  diet  as  the  result  of  enforced  captivity. 
Similar  results  in  other  gardens  in  Europe  w^ere  charged  to  feed- 
ing the  mother  with  meat  wathout  bone,  since  feeding  with  the 
whole  carcass  of  small  animals  greatly  diminished  these  deform- 
ities. If  cleft  palate  were  sometimes  attributable  to  this  cause, 
other  bony  structures  should  likewise  be  involved.  It  is,  hence, 
not  astonishing  to  find  many  lions  born  in  captivity  were  rickety. 
Cleft  palate  has  been  observed  among  dogs,  sheep,  goats,  etc. 
The  question,  however,  whether  domesticity  does  not  play  in 
them  the  alleged  part  of  civilization  in  man,  can  be  solved  only 
by  knowledge   of  the  frequency  of  the   condition  among  wild 

1°  Cited  by  Lombroso,  Criminal  Man. 
11  Etudes  Anthropometriques,  Op.  Cit. 


296  IRREGULARITIES    OF    THE    TEETH. 

animals  of  the  same  family.  In  dealing  with  etiology  the  influ- 
ence of  shock  on  the  mother's  nervous  system  cannot  be 
excluded  in  the  cases  charged  to  feeding. 

The  palate,  it  will  be  remembered,  is  partly  of  bone  and 
partly  of  flesh.  The  fleshy  part  ends  in  what  is  called  the  uvula, 
which  is  very  subject  to  abnormalities.  As  has  been  pointed  out 
by  C.  L.  Dana,  uvula  abnormality  is  very  frequent  in  degener- 
ates. Charles  Dickens  long  ago  noticed  a  uvular  tone  of  voice 
in  vounsf  thieves. 


CHAPTER   XXV. 


DEVELOPMENTAL  NEUROSES  IN  TEETH  POSITION. 

Arrest  of  developntcnt  is  confined  mostly  to  the  upper  jaw ; 
hence  V  and  saddle-shaped  arches  are  more  numerous  than 
irregularities  of  the  lower  jaw.  Local  conditions,  such  as  pre- 
mature extraction  of  the  temporary  teeth,  causing  the  first  per- 
manent molars  to  move  forward,  thus  diminishing  the  size  of  the 
jaw,  are  causes  of  irregularities. 

The  manner  of  these  formations  is  as  varied  as  the  pecul- 
iarities themselves. 


Fig.  i-;>i. 


The  only  structures  involved  in  the  formation  of  these 
deformities  are  the  jaws  and  alveolar  process  on  the  one  hand 
and  the  teeth  upon  the  other.  The  alveolar  process  is  soft  and 
yielding,  while  the  teeth  and  jaws  are  composed  of  hard,  unyield- 
ing substances.  The  process  adapts  itself  to  the  conformation 
of  the  teeth.  The  teeth  of  the  superior  and  inferior  maxilla 
constitute  a  dental  arch  and  the  first  permanent  molars  perform 
the  function  of  keys  to  the  arch.  The  jaws  and  teeth,  like  the 
lateral  halves  of  the  body,  develop  independently  of  each  other, 
each  possessing  peculiar  characteristics  as  regards  irregularities 

2y7 


298 


IRREGULARITIES    OF    THE    TEETH, 


of  the  teeth.  To  simplify  classification  of  irregularities  of  the 
teeth  the  lateral  halves  of  the  jaws,  which  are  separated  by 
the  median  line,  will  be  denominated  the  right  and  left  inferior 
and  the  right  and  left  superior  dental  arches.  While  these  terms, 
as  applied  to  the  lateral  halves  of  the  maxillary  bones,  are  not 
strictly  correct  from  an  architectural  point  of  view,  still  (as  will  be 
seen)  they  answer  the  purpose  for  which  they  are  employed. 

The  manner  of  the  formation  of  the  V-shaped  arch  and  kin- 
dred deformities  may  be  compared  to  the  construction  of  an  arch. 
The  changes  which  take  place  in  the  movement  of  the  teeth 
are  very  similar  to  those  which  may  occur  in  an  arch  of  faulty 


Fig.  1^. 

construction.  Figs.  121,  122  and  123  represent  one  normal  arch 
and  five  varieties  of  irregularities  of  the  teeth.  Each  lateral  arch 
is  viewed  as  containing  stones  corresponding  in  number  and 
size  with  the  teeth  of  a  normal  upper  denture.  Fig.  121  repre- 
sents two  arches.  The  left  superior  arch  is  perfect.  The  first 
stone  is  marked  "posterior  base"  and  corresponds  to  the  first 
permanent  molar.  The  second  stone  is  the  "anterior  base;"  it 
corresponds  to  the  central  incisor.  The  next  stone  is  located 
upon  the  anterior  base  and  corresponds  to  the  lateral  incisor. 
The  succeeding  stones  are  laid  upon  the  posterior  base  and 
represent  the  first  and  second  bicuspids.  The  stone  correspond- 
ing to  the  first  bicuspid  is  usually  in  position  first,  but  some- 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION, 


299 


times  the  stone  corrcsponcHn£^  to  the  second  bicuspid  is  placed 
first.  To  complete  the  arch  it  is  necessary  to  place  the  "key- 
stone" in  position — the  cuspid  tooth.  If  the  stones  have  proper 
proportions  and  measurements  be  correct,  the  key-stone  will  fit 
into  place  and  the  arch  will  be  complete.  On  examining  the 
foundations,  two  more  stones  arc  found,  which  correspond  with 
the  second  and  third  molars ;  these  stones  with  the  base  and 
the  stones  above  the  base  making  a  strong  abutment. 

In  order  that  aberrations  from  the  normal  may  be  under- 
stood a  normal  arch  must  first  be  adopted  as  a  standard. 

There  are  three  characteristics  of  the  normal  arch.     Inde- 


Fio-.  123. 


pendent  of  temperamental  peculiarities,  the  line  extending  from 
one  cuspid  to  another  should  be  an  arc  of  a  circle,  not  an  angle 
or  straight  line ;  the  lines  from  the  cuspids  to  the  third  molar 
should  be  straight,  curving  neither  in  nor  out,  the  sides  not 
approximating  parallel  lines.  Absolute  bilateral  uniformity  is 
not  implied  in  this  since  the  two  sides  of  the  human  jaw  are 
rarely  if  ever  wholly  alike.  A  uniform  arch  necessitates  uni- 
formity of  development  between  the  arch  of  the  maxilla  and 
the  arch  of  the  teeth  and  a  correct  relation  of  the  individual 
teeth  to  each  other.  When  there  is  inharmony  of  development 
between  the  jaw  and  the  teeth,  as  may  happen  when  one  parent 
has  a  small  maxilla  with  correspondingly  small  teeth  and  the 


300 


IRREGULARITIES    OF    THE    TEETH. 


Other  a  large  one  with  correspondingly  large  teeth,  if  the  child 
inherit  the  jaw  of  one  and  the  teeth  of  the  other,  irregularities 
must  occur.  Such  difference  in  diameter  between  the  arch  of 
the  maxilla  and  that  of  the  crowns  of  the  teeth  is  a  constitutional 
cause  of  irregularity. 

Whenever  there  is  a  difference  between  these  diameters,  the 
line  formed  by  the  teeth  must  either  fall  outside  or  within  the 
arch  of  the  maxilla  and  irregularities  of  arrangement  must  result. 

In  Fig.  121,  in  the  right  superior  arch,  the  diameter  of  the 
stones  is  either  too  small  for  the  curve  of  the  arch  or  the  bases 
are  set  too  far  apart.  This  results  in  a  greater  space  for  the 
key-stone  than  is  required;  not  finding  support,  it  drops  through 
toward  the  center  line. 


Fig.  134. 

In  Fig.  122,  in  the  right  superior  arch,  the  posterior  base  and 
the  foundation  stones  have  been  brought  forward  to  such  an 
extent  that  when  the  other  stones  are  placed  in  position,  the 
space  intended  for  the  key-stone  is  closed  and  the  key-stone 
remains  outside.  The  key-stone  appears  too  heavy  for  the  left 
superior  arch  and  its  weight  has  carried  the  smaller  stones  with 
it.  The  posterior  base  with  its  foundation  stones  being  the 
strongest,  resists  the  force ;  the  anterior  base  being  weak  and 
without  support,  bulges  out  and  in  this  way  a  semi- V-shaped 
arch  is  produced. 

In  Fig.  123  the  key-stone  has  gradually  carried  the  right 
superior  arch  inward ;  the  posterior  base  is  in  its  proper  position, 
the  anterior  base  has  been  carried  forward  and  all  the  stones 
are  in  line.  The  key-stone  in  the  left  superior  arch  has  produced 
the  same  result  as  upon  the  opposite  side,  excepting  that  the 
posterior  base  and  the  foundation  stones  were  placed  too  far 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION.  301 

forward,  leaving  insufficient  space  for  the  key-stone.  The  teeth, 
however,  do  not  bear  the  same  relation  to  each  other  upon 
their  approximal  surfaces  that  the  stones  of  the  arches  do.  The 
stones  of  an  arch  have  broad  flat  surfaces,  while  the  teeth  merely 
touch  upon  the  points  of  rounded  surfaces. 

The  ten  anterior  teeth,  which  are  involved  in  the  construc- 
tion of  the  V-shaped  and  kindred  irregularities,  are  ilkistrated 
in  Fig.  124,  in  which  the  positions  of  the  roots  and  crowns  and 
their  mutual  relations  are  approximately  shown.  As  will  be 
observed,  the  teeth  are  all  wedge-shaped,  the  bases  being  located 
near  the  cutting  and  grinding-edges  and  the  apices  at  the  ends 
of  the  roots.  These  are  nearly  round  and  conical,  the  points 
of  antagonism  being  near  or  quite  at  the  cutting  edge  or  grind- 


Fig.  125. 


ing  edges.  Fig.  125  shows  a  section  of  the  teeth  at  their  points 
of  contact.  These  points  must  be  kept  in  mind,  as  they  consti- 
tute the  fulcra  of  the  levers,  which,  when  force  is  applied  to  the 
teeth,  cause  them  to  rotate  and  move  out  of  position,  thus  pro- 
ducing more  varieties  of  deformities  than  it  is  possible  to  dem- 
onstrate upon  the  stone  arch. 

These  irregularities  are  not  observed  until  after  the  eruption 
of  the  second  set  of  teeth.  The  first  permanent  molars  are 
largest,  -strongest  and  possess  largest  roots  of  any  teeth.  They 
are  located  posteriorly  to  the  temporary  set.  Owing  to  their 
position  and  to  their  long,  large  roots,  their  apices  are  directed 
backward.  In  a  majority  of  cases,  the  distance  from  the  apex 
of  one  root  to  that  of  another  is  greater  than  at  the  neck,  which 
indicates  that  they  are  firmly  fixed  in  their  alveoH.    The  alveolar 


302 


IRREGULARITIES    OF    THE    TEETH. 


process  is  wide  at  those  points,  hence  these  teeth  may  be  desig- 
nated as  the  posterior  basis  of  the  lateral  arches. 

The  next  teeth  which  make  their  appearance  are  the  central 
incisors.  These  are  situated  in  the  extreme  anterior  alveolar 
process  on  either  side  of  the  median  line.  The  process  is  quite 
thin  at  these  points.  These  teeth  will  be  called  the  anterior 
bases  of  the  lateral  arches.  The  next  to  make  their  appearance 
are  the  lateral  incisors,  which  take  positions  at  the  distal  surfaces 
of  the  central  incisors.  The  roots  of  these  teeth  are  not  so  large 
nor  so  long  as  the  roots  of  the  centrals,  hence  they  are  not 
as  firmly  fixed  in  the  alveoli.  Each  lateral  tooth,  however,  is 
supported  by  the  central  and  represents  the  second  stone  upon 


Fig.  126. 


Fi^  127. 


the  anterior  base.  The  teeth  which  appear  are  the  first  bicuspids. 
Immediately  following  are  the  second  bicuspids,  which  repre- 
sent the  second  and  third  stones  upon  the  posterior  bases.  The 
arches  are  then  complete,  except  the  key-stones — the  cuspid 
teeth.  These  cannot  be  omitted,  for  they  bind  and  hold  the  teeth 
together  and  give  beauty  and  shape  to  the  arches.  The  follicles 
of  these  teeth  are  originally  situated  outside  of  and  above  the 
crown  and  roots  of  the  teeth  already  in  the  arch,  which  results 
in  a  larger  circle,  and  because  these  teeth  have  long,  powerful 
roots,  unusual  power  and  leverage  is  given  them.  For  this 
reason  they  are  directed  downward  and  inward,  their  crowns 
being  so  located  that  the  lips  assist  greatly  in  aiding  the  down- 


DEVELOPMKNTAL    NEUROSES    IN    TEETH    POSITION. 


303 


ward  movement  of  these  teeth.  The  downward  and  inward 
movement  of  the  cuspids  is  similar  to  the  lowering  of  the  key- 
stone in  an  arch.  It  continues  to  move  downward  until  it 
meets  with  an  obstruction,  which  may  be  confined  to  the  upper 
jaw  and  include  the  teeth  anterior  and  posterior  to  the  cuspid. 
If  the  teeth  in  position  be  in  harmony  with  the  jaw,  the  cuspids 
will  descend  into  their  proper  places  and,  touching  the  teeth 
on  each  side,  lock  the  arches  and  hold  the  teeth  in  proper 
position. 

In  the  posterior  parts  of  the  mouth  the  alveolar  process  is 
very  thick  and  the  base — the  first  permanent  molar — is  large, 
having  three  roots   in   the  upper  and   two  in   the  lower  jaw, 


Fig.  128. 

curved  and  so  arranged  in  the  alveolar  process  as  to  preclude 
its  going  backward.  Other  teeth  of  nearly  equal  strength  are 
found  posterior  to  the  first  permanent  molars.  Anterior  to  the 
base — the  first  permanent  molar — the  first  and  second  bicuspids 
are  found.  These  teeth  are  all  firmly  imbedded  and  situated 
in  the  long  axis  of  the  alveolar  process,  forming  together  a  very 
firm  base.  The  anterior  column  of  the  arch  consists  of  but  two 
teeth,  while  the  posterior  column  has  five.  The  anterior  teeth 
possess  single  roots  and  are  situated  crosswise  in  a  very  thin 
alveolar  process,  hence  the  comparative  weakness  of  the  anterior 
arch.  In  some  intances  the  space  may  be  too  large  in  the 
superior  arch  and  the  key-stone  or  cuspid  tooth  may  continue  in 
its  downward  course  till  it  engages  with  the  teeth  in  the  lower 
jaw. 


304 


IRREGULARITIES    OF    THE    TEETH. 


The  V-shaped  arch  presents  a  triangular  outhne  (Fig.  126), 
the  apex  of  the  triangle  being  formed  by  the  central  incisors, 
where  the  process  is  usually  bent  so  that  the  incisors  form 
an  angle  instead  of  being  in  line.  From  this  apex  the  lateral 
halves  are  in  a  straight  line,  terminating  at  the  first  molars ;  a 
line  connecting  them  forms  the  base  of  the  triangle.  The  cause 
of  this  peculiar  outline  is  a  want  of  correspondence  between 
the  size  of  the  jaw  and  teeth  or  the  premature  extraction  of  the 
temporary  molar  or  both  causes  combined,  thus  allowing  the 
first  permanent  molars  to  move  forward.  When  the  rest  of  the 
permanent  teeth  come  in,  they  are  crowded  together.  The 
process  must  give  way  in  order  to  adapt  the  greater  arch  formed 
by  the  crowns  of  the  teeth  to  the  lesser  arch  of  the  maxilla.    The 


Fig:   129 

point  of  fracture  is  in  or  near  the  median  line,  since  the  process 
is  thinnest  at  this  point.  The  illustrations  given  here  show 
varieties  of  this  type.  By  comparing  each  one  with  the  diagram 
it  will  be  seen  that  they  all  are  triangular  in  outline,  Fig.  129 
being  the  best  representation  of  this  form  of  irregularities.  A 
line  passing  from  the  median  line  of  the  central  incisors  through 
the  cutting  edges  and  crowns  is  straight.  Study  of  the  cases 
here  given  will  reveal  the  result  of  the  forward  movement  of  the 
first  molar.  The  subsequent  loss  of  teeth,  the  peculiarity  of 
articulation  and  the  thinness  of  the  process  at  certain  points 
determine  the  modifications.  In  Fig.  127  the  laterals  are  gone ; 
for  the  reason  the  centrals  are  still  in  line,  space  having  been 
made  by  the  absence  of  the  laterals.     In  Fig.  128  it  is  evident 


DEVELOl'MENTAL    NKUROSKS    IN    TEKTH    POSITION.  305 

from  its  ovcrla]>ping;  centrals  that  tlierc  was  want  of  sj^ace  at  the 
time  of  their  eruption ;  tlie  loss  of  the  second  bicuspids  suhse- 
ijuently  haw,  together  with  peculiarities  of  articulation,  ])er- 
mitted  the  lateral  halves  to  assume  some  curvature.  In  Im_<(. 
127  there  is  an  arch  too  small  for  the  teeth  and  is  destitute  of 
the  right  fust  molar  and  the  left  first  bicuspid.  These  were 
evidently  lost  after  the  central  incisors  were  erupted.  The  rest 
of  the  teeth  have  migrated  more  or  less  because  not  kej)!  in 
place  by  close  articulation.  Thus  the  cuspids  are  kept  out  of  place 
and  by  their  pressure  inward  tend  still  more  to  narrow  the  arch 
anteriorly.  In  Fig.  130  the  central  is  spread,  though  the 
process  is  evidently  bent.  This  spreading  is  accounted  for  by 
the   absence    of   right    lateral,   which   has   allowed   the    central 


Fig-.  ]::!(i. 

to  move  backward  and  the  cuspid  to  move  in.  On  the  left  side 
the  cuspid  has  erupted  inside  of  the  arch. 

Modifications  of  the  V-shaped  arch  result  from  modifications 
of  the  above  named  conditions.  A  difference  in  the  time  of 
eruption  of  the  cuspids,  everything  else  being  equal,  effects  a 
difference  in  the  space  left  for  their  accommodation  and  thus 
partial  \'-shaped  arches  are  found.  The  key-stone  (the  cuspid) 
is  not  entirely  outside  nor  inside  of  the  arch  in  the  partial 
V-shaped  form,  but  may  appear  partially  crowded  out  of  place. 
Hence  the  arch  is  neither  a  normal  curve  nor  w^holly  angular, 
but  unites  the  characteristics  of  both.  Its  lateral  diameter  is 
less  than  that  of  the  normal  arch,  giving  it  a  contracted  appear- 
ance  (Fig.    131).     Thus  a  number  of  varieties   of  the  funda- 

21 


306 


IRREGULARITIES    OF    THE    TEETH. 


mental  forms  of  the  V-shaped  arch  are  formed,  differing  in 
degrees  of  anterior  contraction.  All  of  these  result  from  the 
comparative  thinness  of  the  anterior  portion  of  the  process  offer- 
ing but  little  resistance,  an  abnormal  pressure  from  behind  and 
the  greater  strength  of  the  cuspids,  which  causes  them  to  seek 
room  irrespective  of  the  space  left  for  them.  By  drawing  a 
perpendicular  line  from  the  median  line  of  the  central  incisors 
to  the  base  and  comparing  the  halves  thus  obtained  with  the 
diagram,  the  right  half  in  Fig.  132  is  seen  to  be  partially  V-shaped 
while  the  left  is  normal.  Near  the  apex  is  the  crowded  condition 
of  the  incisor,  overlapping  the  lateral;  from  thence  back  the 
curve  of  the  arch  is  lost.     The  absence  of  the  first  bicuspid, 


Fig.  131. 


Fig.  132. 


together  wdth  the  want  of  proper  articulation,  has  allowed  the 
cuspid  to  press  nearer  the  center  of  the  palate  than  is  normal. 

In  Fig.  133,  the  V-shape  is  not  so  apparent,  but  the  central 
incisors  are  crowded,  which  shows  that  there  is  not  perfect  har- 
mony betwen  size  of  teeth  and  jaw.  This  contracts  the  anterior 
arch. 

When  one  side  of  the  process  near  the  symphysis  is  the 
stronger,  thus  affording  greater  resistance  or  the  pressure  of 
the  cuspid  is  less,  that  side  may  maintain  its  normal  relations, 
while  the  other  may  give  way  to  conditions  resulting  in  a 
V-shaped  contraction.  The  curve  will  then  be  broken,  not  at 
the  apex  of  the  triangle,  but  near  it ;  the  incisors  will  overlap 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION. 


307 


and  when  pressure  from  the  cuspid  acts  on  the  weaker  column 
it  must  give  way.  This  results  in  the  semi-V-shaped  form. 
(Fig.  134.) 

In  Fig.  135  is  a  semi-V-shaped  arch.  The  teeth  in  the  left 
dental  arch  are  nearly  on  a  straight  line.  The  teeth  in  the  right 
dental  arch  arc  situated  upon  a  slight  curve.  In  this  arch  the 
cuspid  is  in  position,  while  ui)()n  the  left  arch  it  is  missing. 
The  posterior  teeth  have  moved  forward  and  filled  the  space 
intended  for  the  cuspid.  It  is  still  located  in  the  alveolar  jirocess, 
but  the  force  produced  by  the  inward  pressure  of  the  cuspid  is  so 
Sfreat   that   the   central   and   lateral   incisors   have   been   carried 


Fig.  m. 

forward  and  the  teeth  and  alveolar  process  have  produced  the 
straight  line.  The  lateral  pressure  of  the  teeth  prevents  their 
being  carried  farther  inward.  The  lack  of  proper  antagonism 
of  the  central  incisors  has  allowed  the  cuspid  to  force  the  incisor 
and  alveolar  process  forward  until  the  basilar  ridge  of  the  right 
central  antagonizes  with  the  mesial  surface  of  the  left  central. 
This,  in  a  measure,  checks  the  progress  of  the  cuspid  inward 
and  holds  the  arch  on  a  slight  curve.  A  perpendicular  line 
drawn  from  the  mesial  surface  of  the  right  central  incisor  (Fig. 
136)  to  the  base  shows  the  left  side  to  be  V-shaped,  while  the 
right  is  normal.  In  Fig.  137  the  outline  does  not  clearly  point 
to  a  V-shaped  arch.  By  comparing  the  curvature  of  the  two 
halves  and  noting  the  position  of  the  right  cuspid,  it  is  more 


308 


IRREGULARITIES    OF    THE    TEETH. 


apparent.  The  bending  of  the  process  at  the  mesial  line  is  evi- 
dent from  the  position  of  the  right  central.  This  has  turned 
upon  its  axis  from  want  of  lateral  antagonism  and  proper  occlu- 
sion. This  partial  rotation  has  allowed  the  lateral  to  move  back, 
occupying  in  part  the  space  of  the  cuspid,  which  has  forced  the 
cuspid  out  of  its  normal  position,  causing  it  to  erupt  outside  of 
the  arch. 

Fig.  138  shows  a  combination  of  semi-V  and  partial  V-shaped 
arches.  The  cuspid,  being  outside  of  the  left  arch,  contracts  it 
and  gives  it  the  characteristics  of  the  V-shaped.  On  the  right 
side  the  cuspid  is  partially  crowded  out  of  place  and  the  arch 
is  somewhat  contracted. 


Fig.  134. 


Fig.  135. 


The  lower  jaw  never  assumes  the  V-shape  when  the  teeth 
articulate  normally,  because  the  anterior  inferior  teeth  normally 
close  inside  of  the  upper  teeth,  and,  while  the  force  from  im- 
proper occlusion  of  the  jaws  and  the  forward  movement  of  the 
posterior  lower  teeth  is  as  great  or  greater  than  the  like  force 
exerted  upon  the  upper  jaw,  the  forward  movement  of  the  cen- 
tral incisors  is  prevented  bystrikingtheir  anterior  surfaces  against 
the  posterior  surfaces  of  the  superior  incisors.  There  are  many 
irregularities  of  the  anterior  inferior  teeth  caused  by  the  for- 
ward pressure  of  the  posterior  teeth.  These  are  quite  difficult 
to  regulate,  owing  to  their  intimate  relations  with  the  superior 
incisors.  The  inferior  dental  arch  should  be  divided  into  the 
right   and   left   lateral  arches,   corresponding  to   those  of  the 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION. 


309 


superior  arch.  The  pressure  produced  by  improper  articulation 
and  the  forward  movement  of  the  posterior  columns  (the  bicus- 
pids and  molars)  is  exerted  on  each  lateral  half  independently, 
like  that  in  the  lateral  arches  of  the  upper  jaw.     Each  lateral 


KK 


K 


Fig.  136. 


arch  on  the  lower  jaw  has  its  posterior  base  (the  first  permanent 
molar),  an  anterior  base  (the  central  incisor)  and  the  same  num- 
ber of  stones  in  position  upon  the  bases — the  same  key-stone — 


Fig.  137. 


all  representing  the  same  number  of  teeth  as  are  contained  in 
the  superior  lateral  arches.  The  development  of  each  inferior 
lateral  arch  is  independent  of  the  other,  as  is  the  case  with 
the  superior  lateral  arches.     The  irregularities  of  the  teeth  in 


310 


IRREGULARITIES    OF    THE    TEETH. 


each  lateral  arch  are  independent  of  the  others.  When  the  pos- 
terior column  moves  forward,  if  the  key-stone  (the  cuspid  tooth) 
is  retarded  or  slow  in  coming  into  place,  the  space  is  filled  by 
the  first  bicuspid  and  the  cuspid  remains  outside,  precisely  as 
in  the  superior  lateral  arches.     If  the  pressure  of  the  posterior 


Fig.  138. 


columns  and  the  key-stone  be  uniform,  the  force  will  be  exerted 
against  the  anterior  base  and  the  first  stone  upon  the  base  (the 
central  and  lateral  incisor).  In  this  case  a  different  condition 
exists.  The  anterior  base  and  first  stone  of  the  superior  lateral 
arch  and  the  anterior  inferior  column,  resist  the  force.     Occa- 


Fig.  139. 


Fig.  140. 


sionally,  this  is  so  great  that  the  anterior  columns  of  both 
superior  and  inferior  dental  arches  are  carried  forward.  When 
this  occurs,  the  incisors  upon  the  upper  jaw  protrude.  When 
the  forward  movement  of  the  posterior  column  occurs,  the 
incisor  (or  anterior  column)  will  crowd  past  one  another  like 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION.  311 

the  Sticks  of  a  fan,  provided  the  pressure  be  uniform  in  both 
lateral  arches.  The  six  teeth  which  are  instrumental  in  the  con- 
struction of  these  deformities  are  illustrated  in  Fig.  139.  These 
teeth,  as  will  be  observed,  are  wedge-shaped ;  their  points  of 


FiK-   141. 

contact  are  at  their  cutting  edges ;  slight  oblique  pressure  will 
cause  these  teeth  to  lap  over  each  other.  If  the  pressure  is 
upon  one  side  only,  the  irregularity  will  be  located  on  that  side. 
One  of  the  common  irregularities  is  seen  when  the  key-stone 


Fig.  142. 

or  cuspid  tooth  is  slow  in  erupting.  The  posterior  column 
moves  forward  and  the  resistance  of  the  anterior  column  forces 
the  key-stone  outside  the  arch.  It  sometimes  happens  that  the 
key-stone  moves  into  place  and  is  held  in  position  by  the  anterior 


312 


IRREGULARITIES    OF    THE    TEETH. 


column  and  the  second  stone  upon  the  posterior  column  (the 
first  bicuspid)  is  carried  forward  outside  the  arch.  This  can  be 
better  understood  by  examining  cases  of  this  kind,  which  will  be 
illustrated  later.    In  V\g.  140  is  seen  in  position  a  section  of  the 


Fig.  n;i 
teeth  made  on  the  line  of  lateral  antat^onism.     The  mesial  and 
distal  surfaces  are  convex  and  the  points  of  contact  are  situated 
at  the  extreme  lateral  surfaces.     If  the  teeth  at  eruption  should 
not   touch   at  these   particular  i)()inls,   or   if   the    force   exerted 


Fig.   144. 

should  not  be  in  direct  line  with  these  points  of  contact,  the 
teeth  would  be  situated  upon  an  incline  and  the  force  thus 
applied  would  readily  carry  the  teeth  one  way  or  the  other.  Such 
deformities  occur  more  frequently  with  the  incisor  and  cuspid 


DKVKI.OI'MKN  lAI,    NKTROSKS    IN     Tl'-KI  H     POSITION. 


313 


than  with  the  posterior  teeth.  The  posterior  teeth  are  held  in 
position  by  their  contact  with  the  occhiding  teeth  of  the  oppo- 
site jaw,  while  the  incisors  do  not  occlude.  One  marked  feature 
of  these  irregularities  is  that  in  most  cases  the  lateral  incisor 
is  carried  inward  and  the  centrals  outward  to  remain  in  position 
in  one  or  both  lateral  arches.  These  conditions  are  fully  illus- 
trated in  the  chapter  on  local  causes.  In  Fig.  141  the  right 
dental  arch  is  normal.  In  the  left  dental  arch  the  anterior  col- 
unm  w'ith  the  cuspid  (the  key-stone)  has  moved  forward  and 
the  lateral  incisor  is  carried  inward.  This  is  explained  when 
the  relation  between  the  mesial  surface  of  the  cuspid  and  the 
distal  surface  of  the  lateral  is  understood.    In  the  forward  move- 


Fi.if.  H.-i 


miMiiiffiiiiii iiimiiiiiiiiii  ii 

I  u     14(i 


ment  of  the  cuspid  the  lateral  impinges  upon  a  markedly  incHned 
plane  upon  the  mesial  surface  of  the  cuspid  and  the  forward 
pressure  carries  the  lateral  inward.  In  Fig.  142  is  the  same 
irregularity  in  both  right  and  left  lateral  arches,  the  pressure 
being  uniform  upon  each  arch.  The  centrals  are  also  slightly 
rotated  in  their  sockets.  This  is  produced  by  the  flat  lateral 
surfaces  of  the  roots  meeting  and  the  pressure  of  the  crowns 
against  the  basilar  ridges  of  the  superior  centrals. 

The  saddle-shaped  arch  is  not  so  common  a  deformity  as  the 
V-shaped.  It  has  many  peculiarities,  however,  that  are  seen  in 
the  V-shaped,    It  may  include  one  or  both  lateral  arches.    It  may 


314 


IRREGULARITIES    OF    THE    TEETH. 


be  partial  on  one  side  and  marked  on  the  other.  It  may  involve 
the  bicuspids  and  first  permanent  molars  upon  one  side  or  but  a 
single  tooth  on  the  other.  Each  lateral  arch  produces  its  own 
deformity  independently  of  the  other.  The  roof  of  the  mouth 
may  be   high   or  low.     The   deformity,   like   the   A'-shaped,   is 


Fig.  147. 


favored  by  the  high  arch.  In  Fig.  143  is  seen  the  manner  of  pro- 
duction of  this  deformity.  Here  is  a  right  and  left  superior 
lateral  arch  of  stone,  each  stone  corresponding  in  size  and  loca- 
tion to  the  natural  teeth.     The  left  lateral  stone  arch,  corre- 


sponding  to  the  left  superior  dental  arch,  shows  the  formation 
of  the  saddle-shaped  arch  and  order  of  laying  the  stones  and 
changing  the  base.  The  first  stone  laid  in  the  arch  corresponds 
to  the  first  permanent  molar,  and,  like  the  stone  in  the  V-shaped 
arch,  is  denominated  the  posterior  base.     The  next  stone  laid 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION. 


315 


corresponds  to  the  central  incisor,  then  the  stone  which  stands 
for  the  lateral  incisor.  The  natural  order  then  changes  and  the 
next  stone  laid  corresponds  to  the  key-stone  of  the  V-shaped 
arch  (the  cuspid).  It  becomes  the  anterior  base  forming  a  fixed 
point  in  the  anterior  part  of  the  mouth.  The  next  stone  laid 
corresponds  to  the  first  bicuspid,  followed  by  those  representing 
the  second  bicuspid  and  the  second  and  third  molars.  The 
stones  being  in  position,  the  anterior  and  posterior  columns 
are  nearly  equal  in  strength  and  resisting  power.  The  anterior 
column  is  made  up  of  the  anterior  base  (the  cuspid)  with  its 
long  root,  backed  up  by  two  foundation  stones  representing  the 
central  and  lateral  incisors.     The  posterior  column  is  made  up 


of  its  base,  the  first  permanent  molar  backed  by  two  foundation- 
stones  representing  the  second  and  third  molars.  The  forward 
movement  of  the  posterior  column  takes  place  in  the  arch  from 
the  same  causes  which  produce  the  forward  movement  in  the 
V-shaped  arch.  The  stone  representing  the  cuspid  is  not  the 
stone  involved ;  it  is  always  fixed  in  its  proper  place.  The 
weaker  stones  are  those  which  correspond  to  the  bicuspids  and 
they  are  the  stones  which  are  always  displaced  when  the  forward 
movement  of  the  posterior  column  occurs.  The  change  in  the 
order  of  the  laying  of  the  stones — i.  e.,  the  stones  corresponding 
to  the  cuspid  instead  of  the  bicuspid  (it  being  irregular) — accounts 
for  there  being  fewer  saddle  than  V-shaped  arches.  The  change 
of  the  anterior  base  will  also  explain  why  the  anterior  column 


31G  IRREGULARITIES    OF    THE    TEETH. 

and  alveolar  process  do  not  project,  as  in  the  case  of  the  V-shaped 
arch.  The  right  superior  lateral  arch  illustrates  another  com- 
mon variety  of  the  saddle-shaped  arch.  It  does  not  differ 
materially  from  the  left  lateral  arch  as  regards  the  order  of 
laying  the  stones.  The  anterior  base  is  transferred  one  stone 
back,  the  stone  corresponding  to  the  first  bicuspid.  The  posterior 
base  remains  the  same.  The  posterior  column  moves  forward 
and  carries  the  stone  representing  the  second  bicuspid  inward. 
On  comparing  the  shapes  of  the  natural  teeth  with  the  stones 
in  the  arch  just  described,  it  is  found  that  the  approximate  sur- 
faces are  convex  instead  of  flat  like  those  of  the  stone  arch  just 


I 

Fig.  151. 

described.  The  peculiar  incline  of  the  anterior  surface  of  the 
first  permanent  molar  and  the  posterior  surface  of  the  cuspid 
tooth,  together  with  the  oval  shapes  of  the  bicuspids,  are  singu- 
larly well  adapted  to  cause  these  irregularities  upon  the  applica- 
tion of  force.  The  first  permanent  molars  are  situated  farther 
outside  in  the  arch  than  any  teeth  posterior  to  them.  The  cus- 
pids occupying  such  a  prominent  position  in  the  arch  in  the 
anterior  part  of  the  mouth,  the  least  deviation  inward  of  the 
bicuspids  would  give  the  pinched  appearance  of  the  jaw  at  that 
locality.  In  neurotics  and  degenerates  the  jaws  will  in  some 
cases  develop  in  length  and  not  in  width.  In  such  cases  the 
jaws  at  the  sixth  and  seventh  year  remain  permanent.     The 


DEVELOPMENTAL    NEUROSES    IN    TEETH    POSITION. 


317 


temporary  molars  hold  the  permanent  bicuspids  in  the  unde- 
veloped position  and  the  cuspids  erupt  outside  the  arch.  In  this 
way  a  full  saddle  is  formed.  This  deformity  is  caused  also  by 
the  too  early  extraction  oi  the  temporary  molars,  which  allows 
the  first  permanent  molars  to  work  forward  and  force  the  bicus- 
pids inward,  or  by  the  retention  of  the  temporary  molars  or  their 
roots,  thus  deflecting  the  crowns  of  the  bicuspids.  The  question 
arises,  why  are  not  the  bicuspids  forced  outward  as  well  as 
inward?  They  do  occur  frequently  cnitside  the  arch.  The 
inward  movement,  however,  is  the  natural  one,  because  the 
crowns  when  in  the  jaw  are  situated  between  the  roots  of  the 


Fig.  152. 


Fig.  153. 


temporary  molars.  The  temporary  molars  are  situated  upon 
a  smaller  circle  than  the  permanent  molars  and  cuspids  (Fig. 
144).  When  the  temporary  molars  are  extracted,  the  crowns 
of  the  bicuspids  are  in  the  radius  of  a  smaller  circle,  while  their 
roots  have  been  carried  outward  by  the  development  of  the  jaw 
and  alveolar  process. 

The  molars  in  the  saddle  and  semi-saddle-shaped  arches  of 
the  upper  jaw  frequently  diverge  laterally.  If  the  case  shows 
a  semi-saddle-shaped  arch,  the  divergence  is  on  the  side  of  the 
deformity.  If  both  lateral  arches  are  involved,  both  sides  diverge. 
Cases  having  the  deformity  most  prominently  have  the  most 
marked  divergence.  When  a  slight  change  exists  only  at  the 
bicuspid  region,  the  divergence  in  the  molar  region  is  slight. 


318 


IRREGULARITIES    OF    THE    TEETH. 


This  peculiar  arrangement  of  the  molar  teeth  may  be  due  to 
two  causes  :  First,  the  teeth  upon  the  lower  jaw  diverge  on 
account  of  the  shape  of  the  inferior  maxilla ;  the  farther  removed 
from  the  incisors,  the  greater  the  distance  between  the  molars 
of  the  opposite  side.  The  molars  upon  the  upper  jaw  usually 
articulate  with  those  upon  the  lower  jaw.  The  disparity  in  the 
appearance  of  the  normal  position  of  the  teeth  and  those  above 
described  is  due  to  the  pinched  condition  in  the  bicuspid  and 
first  molar  region  rather  than  to  the  position  of  the  molars. 
Second,  when  the  arch  is  contracted  at  the  bicuspid  region  the 
tongue  goes  to  the  roof  of  the  mouth  and  is  then  forced  back- 
ward for  lack  of  room,  thus  shortening  and  consequently  broad- 


Fig.  154. 


Fig.  155. 


ening  its  surface.  The  result  of  the  lateral  expansion  would 
naturally  be  to  force  the  teeth  and  alveolar  process  outward. 

The  position  of  the  temporary  molars  determines  the  position 
of  the  bicuspids.  This  position  shows  the  diameter  of  the  jaw 
early  in  life.  From  that  time  until  the  eruption  of  the  third 
molar,  i.  e.,  from  the  third  to  the  twentieth  year,  the  jaw  has 
no  opportunity  to  develop,  which  naturally  carries  the  alveolar 
process  and  teeth  out  laterally,  causing  the  crowns  of  the  third 
molar  to  face  the  cheek  sometimes. 

When  there  is  harmony  between  the  size  of  the  teeth  and 
that  of  the  arch  and  the  permanent  bicuspids  erupt  under  favor- 
able conditions,  so  that  their  greatest  diameter  is  in  a  line  with 
the  greatest  diameter  of  both  first  cuspid  and  molar,  they  will 


DEVELOI'MENTAL    NEUROSES    IN    TEETH    POSITION.  319 

be  held  firmly  in  place,  since  the  greatest  pressure  is  on  this 
very  line.  On  the  other  hand,  when  the  bicuspids  are  erupted 
after  their  proper  time,  while  the  cuspids  progress  duly,  the  cus- 
pids, meeting  with  no  resistance,  fall  into  their  natural  position, 
while  the  bicuspids  erupt  inside  of  the  arch,  forming  an  angle. 
This  angle  results  from  two  causes — thinness  of  the  process  at 
this  point  and  diminution  of  resistance  which  must  follow. 

In  Figs.  145  and  146  is  seen  a  decidedly  saddle-shaped  arch. 
The  maxillary  bone  is  too  narrow  at  its  anterior  extremity  for 
the  teeth,  which  are  suited  to  a  more  expanded  jaw.  The  consti- 
tutional tendency  to  this  deformity  is  quite  apparent  in  this  case. 
The  vault  is  high  and  narrow.     The  first  molars  are  pushed 


■J 


%  '':fm;^yj 


Fig.  156. 


forward,  leaving  only  sufficient  space  on  each  side  for  one  bicus- 
pid. These  are,  therefore,  turned  inward  toward  the  palate, 
making  the  vault  at  this  point  still  narrower  than  it  natur- 
ally is. 

When  the  unfavorable  conditions  that  result  in  the  saddle- 
shaped  arch  are  not  so  pronounced  we  have  the  partial  saddle- 
shaped  arch  (P^ig.  147).  Thus,  because  of  the  greater  uniformity 
of  the  maxilla  and  of  the  crowns  there  may  be  more  space  and 
the  bicuspids  may  be  forced  but  little  out  of  place,  or  the  molar 
may  move  forward  but  slightly,  interfering  less  with  the  bicus- 
pids. Sometimes  it  happens  that  in  trying  to  adjust  themselves 
to  the  Hmited  space  one  bicuspid  may  be  crowded  outward  and 
another  inward.  Sometimes  the  first  bicuspid  is  in,  more  fre- 
quently the  second  (Fig.  148). 


320  IRREGULARITIES    OF    THE    TEETH. 

In  Figs.  149  and  150  are  found  a  normal  arch  on  the  left 
side  and  a  saddle-shaped  arch  on  the  right.  The  vault  is  normal 
in  this  case ;  hence  there  is  more  room  for  the  erupting  bicus- 
pids and  less  curvature  results  than  is  found  in  Fig.  148.  Fig. 
151  shows  a  similar  condition  of  the  left  side. 

How  the  V  and  saddle-shaped  arch  niav  he  combined  on 
one  side  remains  to  be  ex])lained.  Given  lliinness  of  process  in 
the  anterior  part  of  the  mouth,  premature  or  tardy  extraction  of 
the  first  molar  and  there  will  be  a  forward  movement  of  the 
incisors.  The  development  of  the  cuspid  will  press  the  alveolar 
process   inward,   thereby   contracting  the   arch   and   the   tardily 


Fig.  157. 

erupted  bicuspids  will  adjust  themselves  to  the  limited  curve 
as  before  stated.  In  this  way  the  features  of  the  two  forms  are 
combined ;  that  is  a  contracted  or  angular  anterior  arch  and  a 
posterior  arch  more  or  less  concave.  The  opposite  side  may 
be  V-shaped,  saddle-shaped  or  normal  (Figs.  152  and  154). 

In  Fig.  153  occurs  a  combination  of  V  and  saddle-shaped 
arch  on  the  left  side  and  \"-shaped  on  the  right.  In  Figs.  154 
and  155  is  seen  a  case  of  semi-V  and  semi-saddle-shaped  arches 
combined. 

In  Fig.  156  appears  a  semi-saddle-shape  in  the  right  lateral 
arch ;  the  second  biscuspid  has  been  forced  inside  the  arch. 
The  opposite  side  shows  a  condition  exactly  reversed.  The 
points  of  lateral  antagonism  of  the  second  bicuspid  are  outside 


DKVKl.dl'.MKNTAL    NEUROSES    IN    TKETII    I'OSITION, 


321 


the  long  diameter  of  tli€  dental  arch.  The  anterior  movement 
of  the  posterior  base  forced  the  tooth  outward.  The  tendency  of 
this  irregularity  was  to  form  the  V-shaped  variety.  The  irregu- 
larity of  the  left  lateral  arch  (Fig.  157)  is  a  common  one.  The 
teeth  develop  normally,  but  the  second  bicuspid  is  either  retarded 
in  development  or  deflected  inward  by  a  local  cause.  The 
anterior  base  is,  in  this  case,  transferred  to  the  first  bicuspid. 
The  posterior  and  anterior  bases  come  together,  and  the  second 
bicuspid  is  crowded  inward.  The  irregularity  corresponds  to 
the  right  lateral  stone  arch  of  Fig.  143. 

The  saddle-shaped  arch  on  the  lower  jaw  is  generally  due  to 


Fig.  158. 

local  causes,  the  retention  of  the  temporary  molars  being  one. 
The  one  illustrated  is  the  result  of  both  local  and  constitutional 
causes.  This  deformity  is  also  due  to  an  arrest  of  development 
of  the  lower  jaw. 

In  Fig.  158  a  saddle-shaped  irregularity  upon  the  lower  jaw 
is  observable.  The  impression  is  from  the  jaw  of  a  man  fifty-six 
vears  of  age.  The  second  molars  were  extracted  at  the  age  of 
twenty-two.  The  irregularity  was  produced  at  the  time  of  devel- 
opment of  the  teeth.  The  teeth  are  large  and  firmly  set  in  the 
powerful  jaws.  Asymmetry  of  the  jaws  exists.  If  they  had 
developed  in  unison,  this  deformity  would  have  been  prevented. 
The  forward  movements  of  the  posterior  columns  have  carried 
the  cuspids  forward  and  the  lateral  incisors  inward,  so  that  the 

22 


322  IRREGULARITIES    OF    THE    TEETH. 

cuspids  and  centrals  stand  on  a  line.  The  second  bicuspids  and 
first  permanent  molars  have  been  forced  inward  by  the  inclined 
plane  formed  by  the  posterior  surfaces  of  the  first  bicuspids 
and  also  by  the  articulation  of  the  superior  teeth,  which  form 
a  smaller  arch  than  the  lower  teeth.  As  will  be  seen,  the  third 
molars  have  moved  forward  and  nearly  filled  the  spaces  made 
vacant  by  the  extraction  of  the  second  molars.  This  forward 
movement  was  no  doubt  due  to  improper  articulation  with  the 
upper  teeth. 


CHAPTER  XXVI. 


LOCAL     CAUSES     OF     TEETH     IRREGULARITIES- 
UPPER  JAW. 

Local  irregularities  are  found  in  malposition  and  malocclu- 
sion of  individual  teeth,  as  a  result  of  an  accident  (such  as  pre- 
mature or  tardy  extraction  of  temporary  teeth)  or  malposition 
and  malocclusion  resultant  on  constitutional  causes. 

Foremost  in  influence  on  the  relative  position  of  permanent 
teeth  is  the  first  molar.  If  the  temporary  molar  be  extracted 
prematurely,  the  forward  movement  of  the  posterior  column  fol- 
lows it,  the  expanse  of  the  anterior  column  producing  more  or 
less  vicious  position,  relation  and  occlusion.    The  anterior  move- 


Fig.  159. 


ment  of  the  temporary  molars  and  cuspids  as  well  as  the  perma- 
nent bicuspids  and  cuspids  from  the  great  force  exerted  by  the 
first  permanent  molar  occurs  the  same.  To  this  even  the  cuspid, 
though  most  influential  in  the  anterior  colunm,  must  yield.  Next 
to  the  first  permanent  molar  in  importance  is  the  cuspid.  It 
asserts  itself  above  the  rest  because  of  its  vital  force,  length 
of  root,  pecuHar  shape  and  location  in  the  jaw.  The  length 
of  its  roots  allows  it  to  be  deviated  most  of  any  tooth  from  its 
original  position,  since  with  the  same  degree  of  pressure  brought 
to  bear  on  or  near  the  apex  of  its  root  a  tooth  may  diverge  in 
proportion  to  the  length  of  its  roots.  Though  the  angle  be 
the  same  the  divergence  grows  greater  the  farther  the  cusp  is 
from  the  apex. 

The  central  incisor  comes  next  in  importance  and  then  the 
lateral.  The  central  incisor  finds  a  support  in  its  fellow  on  the 
opposite  side,  while  the  lateral  is  the  most  passive  of  teeth.    It, 

323 


324 


IRREGULARITIES    OF    THE    TEETH. 


however,  plays  the  part  of  a  co-ordinating  force.  Without  this 
wedge  the  teeth  would  not  be  retained  in  their  position  and 
occlusion  would  be  disturbed.  Becaus'e  of  its  weakness  and 
short  root  it  is  very  easily  displaced. 

In  the  chapter  on  general  causes  of  irregularities  the  fact 
was  emphasized  that  the  forward  movement  of  the  posterior 
column,  i.  e.,  the  bicuspids  and  molars,  due  to  premature  or 
tardy   extraction,   will   force   the   weaker   anterior   column   and 


Fii?    Ibl 


alveolar  process  forward.  The  pressure  brought  to  bear  upon  it 
from  both  sides  makes  the  arch  of  the  upper  maxilla  greater  than 
that  of  the  lower.  As  a  consequence  occlusion  will  be  want- 
ing or  defective  and  flexion  must  take  place  according  to  posi- 
tion assumed  in  the  eruption  of  each  individual  tooth.  This 
condition  is  greatly  promoted  by  the  pressure  of  the  cuspids, 
which,  in  coming  down,  assert  themselves  at  the  expense  of  the 


Fig.  162. 


weaker  incisors.  But  this  is  not  all.  Much  depends  on  the  size 
and  the  development  of  the  germs  of  the  permanent  incisors. 
When  there  is  strong  vitality  and  they  join  in  the  struggle  for 
existence  between  the  organs,  their  growth  may  be  out  of  pro- 
portion to  that  of  the  alveolar  process.  Owing  to  healthy  nutri- 
tion or  the  nature  of  the  food  that  is  taken  into  the  system  during 
the  time  of  their  development  the  centrals  may  become  very 
vigorous.  This  extraordinary  development  shows  itself  not  so 
much  in  relative  position  of  the  axes  as  in  irregularities  of  the 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW.  325 

cuttings  edges.  These,  from  their  excessive  diameters,  overlap 
slightly.  When  a  temporary  incisor  persists  too  long  in  its 
socket,  the  germ  of  the  permanent  tooth  is  embarrassed  in  its 
eruption.  The  germ  seeks  its  way  out  as  best  it  can  and  as 
projecting  in  a  straight  line  is  out  of  the  question,  it  slips  around 
the  temporary  teeth  and  is  forced  partially  out  of  position.  The 
process  in  this  case  is  not  unlike  that  of  the  germ  of  a  plant  that 
forces  its  wav  out  from  under  a  stone. 


Fig.  163. 


Having  considered  the  cause  of  the  irregularities  of  this 
division,  the  varieties  must  next  attract  attention.  A  form  fre- 
(|uently  met  with  is  found  in  \'-shaped  arches.  The  central  incis- 
ors are  crowded  together  so  that  their  cutting  edges  are  not  in  a 
line,  but  form  an  angle  that  points  forward  (Fig.  159).  This  is 
the  most  natural  form  for  the  flexion  to  assunije.  The  arch 
is  simply  broken  in  front,  fi  iIImw  in;^-  the  general  direction  of  the 


Fig.  IfU. 

pressure.  The  mesial  surfaces  are  parallel ;  the  anterior  angle 
points  forward,  following  the  general  law  of  the  incisors.  The 
force  is  uniform.  Had  the  anterior  column  not  been  forced 
forward  by  the  posterior  one,  these  teeth  would  be  normal  in 
every  respect.  Sometimes  they  overlap  slightly.  Occasionally 
general  axes  of  the  teeth  do  not  converge,  but  diverge.  This 
is  due  to  faulty  occlusion,  the  lower  incisors  acting  as  a  wedge, 
driving  the  upper  incisors  apart  or  from  want  of  occlusion,  they 
follow  their  course  without  guidance  and  support. 


326 


IRREGULARITIES    OF    THE    TEETH. 


Ill  tlie  second  class,  where  the  cutting  edges  form  an  angle, 
which  is  directed  backward  (Fig.  i6o),  the  pressure  from  behind 
by  the  posterior  column  has  met  with  an  obstruction  in  front. 
This  obstruction  exists  in  the  center  of  the  alveolar  process  and 
is  strong  enough  to  resist  in  a  measure  the  pressure  from 
behind.  Hence  the  force  spreads  itself  on  the  lateral  divisions 
of  the  anterior  process.  The  result  is  that  the  mesial  line  is 
formed  behind  the  distal  line  and  an  angle  is  formed.  Here, 
as  in  the  former  case,  occlusion  is  an  important  factor  in  deter- 
mining the  position  of  the  axis.  A  want  of  proper  occlusion 
may  force  the  anterior  teeth  apart.  The  laterals  also,  in  seeking 
their  natural  position,  may  help  to  force  the  distal  surfaces  of  the 
central  incisors  still  more  out  of  place.  Being  wedged  in  between 
centrals  and  the  cuspid  teeth,  the  latter,  by  their  great  force, 
cause  the  centrals  to  vield  to  the  laterals  that  are  wedged  between 


/  \ 


them.  The  mesial  angle  of  the  laterals  infringes  upon  the  innei 
surface  of  the  distal  angle  of  the  centrals.  These  continue  to 
rotate  until  the  entire  mesial  surface  of  the  laterals  rests  against 
the  palatine  surface  of  the  centrals.  Then  the  rotation  natur- 
ally ceases,  the  laterals  forming  an  abutment.  Pressure  being 
exerted  on  both  centrals,  in  this  way  the  angle  is  formed  and 
the  pressure  on  both  sides  being  equal,  they  are  not  thrown 
out  any  farther.  The  direction  of  the  cutting  edges  depends  on 
the  shape  of  the  teeth. 

If  the  diameters  of  the  cutting  edges  much  exceed  those  of 
the  necks  they  necessarily  overlap  to  a  greater  extent. 

When  the  two  centrals  do  not  erupt  harmoniously,  one  over- 
laps (Fig.  i6i).  If,  in  addition  to  this  condition,  the  force  that 
is  brought  to  bear  on  the  anterior  alveolar  arch  be  very  unequal, 
certain  modifications  occur.  An  unequal  pressure  exerted  by  the 
cuspids  in  their  eruption  will  force  one  side  of  the  arch  farther 


LOCAL    TKF.TH    IRREGULARITIES UPPER    JAW.  327 

forward  than  the  other.  When  the  first  molar  on  one  side  has 
been  extracted,  while  that  on  the  other  remains,  the  forward 
movement  is  necessarily  one-sided  and  a  corresponding  irregu- 
larity follows.  The  tardy  extraction  of  temporary  teeth  goes 
far  in  forcing  the  germs  of  the  permanent  teeth  out  of  place. 
Irregularity  in  the  lower  incisors,  through  faulty  occlusion,  modi- 
fies greatly  the  direction  of  the  upper  teeth. 


Fig.  167. 


Sometimes  centrals  projecting  in  a  line  in  front  of  the  later- 
als are  found  (Fig.  162).  In  this  case  the  centrals  erupted  prop- 
erly. The  arch  being  undeveloped,  there  was  not  room  for  the 
laterals.  These  were  carried  forward  by  the  posterior  column 
and  in  by  the  cuspids  and  possibly  driven  in  by  the  lower  incisors, 
which  strike  without,  exaggerating  the  difficulty.  When  this  is 
not  the  case  and  the  laterals  strike  outside  of  the  lower  teeth, 
the  upper  arch  is  too  large  for  the  lower,  and  the  upper  centrals 


Fig,  168. 

not  finding  the  proper  support  below,  are  forced  out  in  a  similar 
manner. 

A  similar  condition  is  that  in  which  the  central  incisors  strike 
within  the  laterals  (Fig.  163).  The  cause  is  the  same;  but  the 
laterals,  in  erupting,  fail  to  find  the  proper  support  and  project 
outward,  while  the  centrals  occlude  properly.  In  this  case  the 
upper  maxillary  arch  is  not  necessarily  too  large  for  the  lower, 
but  the  teeth  are  crowded. 

One  form  of  irregularity  occasionally  met  with  gives  rise  to 


328 


IRREGULARITIES    OF    THE    TEETH. 


a  right  angle  in  the  region  of  the  cuspids,  the  incisors  being  in 
a  straight  Hne  (Fig.  164).  There  are,  of  course,  cases  where  the 
upper  and  lower  arches  resemble  each  other  and  where  the  occlu- 
sion is  fair,  which  hence  cannot  be  classed  under  irregularities. 
When  this  rectangular  appearance  is  found  in  the  upper  jaw 
only,  it  is  evidently  due  to  a  flexion  in  the  region  of  the  cuspids 
caused  by  the  forward  movement  of  the  posterior  column.  The 
anterior  alveolar  column  will  be  found  thick,  and  therefore 
capable  of  resisting  the  pressure  of  the  posterior  column,  and 
the  pressure  is  spent  on  the  weakest  point,  i.  e.,  the  region  of 
tlie  cuspid.  Hence  the  flexion  at  this  point.  There  is  always 
excessive  development  of  the  upper  jaw  and  alveolar  process. 
This  causes  the  teeth  to  erupt  too  far  forward  for  occlusion  with 
the  lower  arch  and  the  lip  draws  them  in  until  they  strike  the 
lower  arch  and  the  long  axes  of  the  teeth  point  inward  instead 


Fig.  170. 

of  outward.  Thus  the  vault  is  brought  forward,  leaving  the 
lower  incisors  without  support. 

The  usual  course  of  eruption  of  the  teeth  and  harmonization 
of  their  development  is  occasionally  disturbed.  The  germs  that 
should  be  directly  over  the  temporary  incisors  may  be  displaced. 
These  should  be  situated  above  and  anterior  to  the  temporary 
teeth ;  but  occasionally  the  germ  is  situated  above  and  deflected 
posteriorly  and  thus  it  is  liable  to  be  erupted  on  the  palatine 
surface.  Displacement  of  the  germs  generally  results  in  vicious 
eruption;  for,  however,  slight  as  the  tooth  progresses,  the  line 
of  its  axes  must  diverge  more  and  more  from  that  of  its  normal 
position.  The  central  incisors  spring  from  a  point  farther  back 
than  it  should  be.  If  the  elevation  of  the  gum  be  followed,  it  will 
be  seen  that  these  two  diverge  more  and  more  toward  their 
cutting  edges.  Thus  tlie  relation  of  their  axes  is  changed  entirely 
and  a  partial  rotation  is  produced  (Fig.  165). 

Again,  if  the  roots  of  the  temporary  teeth  persist,  instead  of 


LOCAL    TEETH    IRREG  U  L  ARITIES— Ul'PKK     |A\V. 


329 


hi'ing  absorbed  as  the  pennanent  teeth  advance,  tlicy  materially 
interfere  with  the  eruption  of  these  and  arc  apt  to  turn  them  out 
of  their  course.  When  one  of  the  conical  roots  of  the  incisors 
infringes  upon  another  not  in  the  same  line,  as  the  teeth  develop 
a  tendency  to  rotation  is  estal)lished  on  the  principle  of  the 
screw.  This  partial  rotation  upon  its  axis  is  more  apparent  the 
greater  the  diameter  of  the  tooth,  since  the  cutting  edge,  usually 
in  line  with  the  other  teeth,  now  partakes  of  the  revolution  of  the 
axis  and  so  forms  an  angle  with  the  arch. 

In  these  cases  when  the  tfjoth  is  fully  erupted  it  finds  a  proper 
resting  place  on  the  opposing  tooth.  Its  malposition  may  be 
corrected  by  the  exercise  of  its  proper  function,  but  it  often  fails 
to  find  this  and  projects  out,  being  without  support. 

Adventitious  germs  appear  occasionally  in  the  alveolar  proc- 
ess.    When  these  are  found  in  the  arch,  they  necessarily  disar- 


Fig.  1,1 


Fig.  r, 


range  the  occlusion  and  throw  the  teeth  out  of  their  proper 
position.  Supernumerary  teeth  usually  appear  at  the  median 
line,  and  then  necessarily  crowd  all  the  teeth  laterally.  Fre- 
quently one  supernumerary  tooth  is  found  exactly  in  the  median 
line  and  centrals  coming  down  to  the  right  and  left  in  the 
arch. 

Occasionally  two  are  found  in  the  position  where  the  centrals 
should  be.  In  such  cases  the  central  incisors  are  generally 
located  outside  and  anterior  to  the  lateral  incisors.  When  a 
supernumerary  is  found  outside  of  the  arch  in  the  median  line 
one  central  may  be  in  position ;  the  other  may  be  thrown  out  or 
in  and  may  be  rotated  45  degrees  upon  its  axis  (Fig.  166). 

The  irregularities  produced  by  the  malposition  of  laterals  are 

1.  Mesial  surface  of  lateral  overlapping  distal  surface  of  cen- 
tral, while  distal  surface  is  in  a  line  with  cuspid. 

2.  Mesial  surface  of  lateral  overlapping  distal  surface  of 
central,  while  distal  surface  is  behind  the  cuspid. 


330  IRREGULARITIES    OF    THE    TEETH. 

3.  Mesial  surface  of  lateral  behind  the  distal  surface  of  the 
central,  while  the  distal  surface  is  in  a  line  with  the  cuspid. 

4.  Lateral  in  a  line  anterior  to  that  of  central  and  cuspid. 

5.  Lateral  in  a  line  posterior  to  central  and  cuspid. 

6.  Lateral  at  right  angles  with  the  line  of  the  incisor  and 
cuspid. 

7.  Lateral  wholly  inside  the  arch. 

The  lateral  is  found  more  frequently  out  of  position  than 
any  other  tooth  because  it  is  the  weakest  tooth  in  the  arch  and 
has  the  shortest  root  and  is  therefore  more  easily  displaced. 

The  position  of  the  central  incisor  is  the  combined  result 
of  the  relative  strength  of  the  alveolar  process,  the  force  brought 
to  bear  upon  it  by  the  posterior  column  and  the  cuspid  and  the 
peculiarities  of  occlusion.  The  lateral,  on  the  other  hand, 
depends  for  its  position  on  the  combined  force  of  central  and 


f^^  '^y^-^  *x,/'  \|j 


Fig.  174. 

cuspid.  Like  other  teeth,  each  lateral  depends  upon  the  environ- 
ments of  its  own  side  of  the  arch,  independent  of  the  other. 
Besides  its  weakness,  two  other  conditions  are  productive  of  its 
change  of  position:  (i)  the  shortness  and  conical  shape  of  its 
root ;  (2)  its  wedge-shaped  crown.  The  shortness  of  its  root, 
together  with  its  conical  outline,  causes  it  to  be  more  easily 
impinged  upon  by  the  root  of  the  incisor,  which  will  produce 
partial  rotation.  The  wedge-shape  of  its  crown  facilitates  rota- 
tion. The  greater  the  diameter  of  the  cutting-edge  in  proportion 
to  that  of  the  root  the  greater  the  degree  of  rotation  must  be 
before  the  lateral  finds  a  resting  place.  If  the  diameter  were 
equal  to  the  space  left  and  there  were  no  impinging  on  the  root, 
there  would  be  no  displacements.  But  when  the  space  is  not 
sufficient  for  the  lateral  and  a  pressure  is  brought  to  bear  on 
one  side  of  either  cutting-edge  or  root,  there  must  be  a  partial 
rotation  which  is  proportioned  to  the  diameter  of  the  cutting- 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW. 


331 


edge.  The  wedge-shaped  character  of  the  crown  assists  in  rota- 
tion, as  the  roimded  angle  of  the  anterior  cusp  offers  less 
resistance  than  a  line  or  surface.  This  gives  rise  to  the  com- 
monest form  of  irregularity  (Nos.  i  and  2,  Figs.  167  and  168), 
in  which  the  mesial  surface  of  the  lateral  overlaps  the  distal 
surface  of  the  central,  while  the  distal  surface  of  the  lateral  is 
either  in  a  line  with  the  cuspid  or  just  back  of  it. 

3.  In  those  cases  where  the  lateral  is  in  a  line  with  the 
cuspid  (Fig.  169),  but  its  mesial  surface  is  behind  the  central, 
the  cuspid  having  a  much  broader  mesial  surface,  affords  a  firm 
abutment  to  the  movement  of  the  lateral,  while  the  mesial  surface 
of  the  latter  easily  glides  over  the  narrow  rounded  distal  sur- 
face of  the  central  incisor.  In  this  case  the  relative  diameter  of 
the  upper  and  lower  maxillse  determines  the  occlusion  and  posi- 
tion in  a  measure.     If  the  lower  maxilla  and  the  upper  be  prop- 


Fig.  1T5. 


Fig.  17 


erly  proportioned,  the  lower  incisor  may  strike  in  front  of  the 
upper. 

4  and  5.  Laterals  not  finding  room  in  the  anterior  column 
are  met  with  in  a  line  in  front  of  that  formed  by  the  central  and 
cuspid  (Fig.  170),  or  behind  it  (Fig.  171).  In  both  cases  rota- 
tion is  not  produced  by  a  one-sided  pressure  either  upon  the 
root  or  cutting  edge.  Whether  the  lateral  is  found  without  or 
within  the  line  depends  upon  the  relative  diameter  of  the  upper 
and  lower  maxillae  and  occlusion.  If  the  proper  relation  exist 
and  the  lower  incisor  strike  within  the  upper,  the  upper  laterals 
will  be  found  outside  the  arch.  When  the  diameter  of  the 
upper  arch  is  greater  than  that  of  the  lower,  its  laterals  may  be 
found  within  the  line  of  the  centrals  and  cuspids.  In  this  case 
the  lower  incisors  must  either  strike  over  the  upper,  which  occurs 


332 


IRREGULARITIES    OF    THE    TEETH. 


when  there  is  a  proper  relation  of  diameters  of  upper  and  lower 
maxillae  or  else  behind  the  upper  laterals.  This  can  occur  only 
when  the  upper  arch  has  a  greater  diameter  than  the  lower. 

6.  A  rotation  of  90  degrees  so  that  the  lateral  is  at  right 
angles  with  a  line  passing  through  centrals  and  cuspids,  can 
occur  only  when  there  is  no  obstruction  to  the  movement  of 
either  root  or  cutting  edge  and  where  there  is  no  proper  occlu- 
sion (Fig.  172). 

7.  Occasionally  a  lateral  is  found  wholly  inside  the  arch. 
The  cause  is  twofold.  Sometimes  the  lateral  is  erupted  so 
tardily  that  the  cuspid  pushes  it  out  of  its  place.  Then,  even 
though  erupted,  the  greater  relative  (Fig.  173)  size  and  strength 
of  the  cuspid  may  in  due  time  crowd  it  toward  the  palate. 

'1  he  cuspid  is  the  most  important  tooth  in  the  anterior  part 


Fig.  ITT. 


Fig.  1T8. 


of  the  mouth  in  regard  to  durability  and  influence  on  expression. 
It  owes  its  durability  to  the  hardness  of  its  tissue,  slowness  of 
its  development  and  simplicity  of  shape.  The  absence  of  sulci 
lays  it  less  open  to  the  inroads  of  caries.  The  pyramidal  shape 
of  its  cusp  gives  it  great  power  of  resistance.  Its  strength 
depends  on  these  conditions  and  the  length  of  its  root,  which 
exceeds  that  of  any  other  tooth.  Owing  to  the  length  of  its  root 
its  cusp  may  move  farther  from  its  normal  axis  without  really 
forming  a  greater  angle  with  it.  It  is  placed  at  the  angle  between 
the  anterior  and  posterior  columns,  forming  the  key-stone ; 
hence  it  is  of  the  greatest  importance  in  expression.  The  shape 
of  the  crown  may  vary  from  the  agreeably  rounded  outline  of 
beauty  to  the  prominence  of  the  tusk  of  a  wild  beast.  The 
limits  of  variation  of  form  and  position  thus  being  greater  than 


LOCAL    TKETH    IRRKC  UL  A  K  ITIES Ul'PKR    JAW. 


333 


those  of  any  other  tooth,  it  attracts  attention  and  helps  to  make 
or  mar  beauty.  Deviations  from  its  normal  position  may  be  due 
to  malposition  of  the  germ  or  crowding  out  of  place. 

When  no  source  of  pressure  upon  the  erupting  tooth  can  be 
recognized,  such  as  is  the  case  when  the  cuspid  erupts  in  the 
vault,  it  is  safe  to  assume  the  former. 


iig  1^' 


In  both  deciduous  and  permanent  sets  as  compared  with 
other  teeth,  the  cuspids  are  late  in  erupting.  In  both  it  nmst 
seek  its  way  between  two  teeth  already  erupted,  hence  its  lia- 
bility to  be  forced  out  of  place. 

The  permanent  cuspid  rarely  erupts  before  the  twelfth  year 
after  the  centrals,  laterals  and  bicuspids  are  in  position.  It  is 
crowded  and  therefore  meets  with  obstacles  in  its  descent.     Its 


Fig.  180. 

crypt  is  placed  above  and  in  front  of  those  of  the  lateral  and 
bicuspid.  As  at  the  age  of  nine  the  roots  of  the  incisors  and 
bicuspids  are  pretty  well  calcified,  the  cuspid  may  be  materially 
hindered  in  its  eruption  by  these  when  there  is  a  lack  of  space.  Its 
conical  root  makes  it  yield  easily  to  pressure  and  its  cusp  glides 
readily  over  the  roots  of  the  adjoining  teeth.  If  its  calcification 
and  the  decalcification  of  the   temporary  teeth  do  not  occur 


334 


IRREGULARITIES    OF    THE    TEETH. 


simultaneously  a  new  factor  of  disturbance  arises,  for,  by  the 
pressure  of  an  additional  obstacle  in  the  shape  of  a  remaining 
portion  of  the  root  of  a  deciduous  tooth,  the  cuspid  may  be 
thrown  out  of  its  course,  while  a  too  rapid  absorption  of  a  decid- 
uous root  leaves  the  column  of  resistance  broken,  thus  opening 
a  new  channel  for  the  erupting  tooth. 

The  position  of  its  crypt  above  and  in  front  of  those  of  the 
lateral  and  bicuspid  accounts  for  the  most  common  form  of 
irregularity,  i.  e.,  being  outside  of  the  arch  and  above  the  other 
teeth.  The  tendency  of  the  cusp  is  necessarily  forward,  because 
the  combined  force  of  the  bicuspids  and  the  first  permanent 
molar  from  behind  is  greater  than  that  of  the  lateral  in  front ; 


Fig.  181. 


hence  the  lateral  is  easily  pushed  out  of  place.  Besides,  the 
roots  of  all  teeth  pointing  backward  naturally  give  it  this  ten- 
dency. 

When  in  its  normal  position  the  cuspid  pushes  its  way 
between  the  roots  of  the  lateral  and  bicuspid,  thereby  spreads 
the  arch,  giving  it  a  parabolic  outline  and  forming  a  key-stone. 
When  it  remains  outside  of  the  arch,  the  expanded  contour 
is  lost  and  a  pinched  condition  results  in  the  shape  of  a  V-shaped 
arch.  The  additional  pressure  of  the  cuspid  upon  the  region 
of  the  lateral  only  increases  this  tendency.  The  cuspid,  when  out 
of  place,  is  usually  found  above  and  outside  of  the  lateral  and 
bicuspid,  this  tendency  being  given  by  the  position  of  its  germ 
and  its  calcification  being  late  as  compared  with  other  teeth. 
(Fig.  174.) 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW. 


335 


One  or  two  cuspids  may  be  found  erupted  in  the  palatal 
vault  when  there  is  a  malposition  of  the  germs  (Fig.  175).  Occa- 
sionally the  cuspid  is  found  outside  of  the  first  bicuspid  or 
between  the  first  and  second  bicuspid,  sometirnes  in  front  or 
anterior  to  the  lateral  (Figs.  176  and  177).  Frequently  it  takes 
the  place  of  the  lateral  (Fig.  178).  Sometimes  one  cuspid  is 
found  in  the  palate,  while  the  other  is  on  a  line  pointing  inward 
(Fig.  179).  When  it  comes  through  in  this  position  the  decidu- 
ous cuspid  may  still  be  in  position,  the  first  bicuspid  having 
crowded  forward  to  the  lateral  (Fig.  180).  Occasionally  when 
the  cuspid  is  missing,  the  lateral  will  drop  backward  (Fig.  181). 
Its  usual  position  when  in  the  palate  is  inside  the  lateral  incisor, 
but  sometimes  it  is  embedded  in  the  hard  palate.  A  pinched 
condition  in  the  bicuspid  region  necessarily  results  from  such 
malposition,  due  in  part  to  want  of  prominence  of  this  tooth 
when  in  normal  position  and  in  part  to  the  inward  pressure  of 
the  cuspid  upon  the  bone-cells  (Figs.  182  and  183).    When  the 


cuspid  moves  out  of  position  it  does  so  at  the  expense  of  the 
first  bicuspid  and  lateral  incisor.  The  force  may  be  so  great  as  to 
push  the  lateral  forward  and  through  the  alveolar  process. 
When  the  cuspid  is  found  in  the  roof  of  the  mouth,  or  out 
of  its  normal  position,  the  posterior  column  moves  forward, 
filling  the  space  usually  occupied  by  the  cuspid  (Fig.  178)  and 
the  half  of  the  arch  of  which  this  tooth  is  a  member  remains 
undeveloped  (Fig.  182).  If  the  cuspid  erupt  simultaneously 
the  pressure  exerted  is  uniform  and  there  is  less  liability  to 
irregularity.  One  may  erupt  normally,  while  the  other  may  be 
abnormal  in  position. 

The  shape  of  the  crown  of  the  bicuspid  renders  it  particularly 
liable  to  irregularities  of  position.  The  antero-posterior  diameter 
of  its  outer  cusp  is  greater  in  proportion  than  that  of  the  inner. 


336 


IRREGULARITIES    OF    THE    TEETH. 


having  a  wedge-shaped  space  on  the  palatal  side.  This  causes 
it  to  touch  at  one  point  the  tooth  in  front  and  back  of  it  and 
makes  rotation  upon  its  axis  easy.  Irregularities  are  chiefly  lim- 
ited to  the  second  bicuspid  for  reasons  that  become  apparent 
when  their  causes  are  considered. 

Like  irregularities  of  other  teeth,  irregularities  of  bicuspids 
may  arise  from  constitutional  causes,  i.  e.,  (from  a  lack  of  accord 
between  the  size  of  the  jaw  and  that  of  the  teeth)  or  from  local 
causes.  The  latter  are  frequent.  They  are  (i)  tardy  eruption; 
(2)  deflection  due  to  the  retention  of  temporary  roots ;  (3)  for- 
ward movement  of  the  molars,  and  (4)  rotation  from  want  of 
occlusion. 


Fig^.  184. 

1.  Tardy  eruption.  The  natural  order  of  eruption  is:  first 
bicuspid,  second  bicuspid,  cuspid.  But  this  is  sometimes  dis- 
turbed, so  that  the  first  bicuspid  is  followed  by  the  cuspid,  thus 
pushing  it  backward.  When  there  is  a  lack  of  space  the  second 
bicuspid  must  seek  its  way  between  the  first  bicuspid  and  the' 
first  permanent  molar  and  if  there  is  a  lack  of  room  it  is  crowded 
outside  or  within  the  arch  (Fig.  184). 

2.  Deflection.  When  a  temporary  molar  is  retained  too 
long  or  its  root  is  not  absorbed  as  fast  as  the  bicuspid  is  erupted, 
this  obstacle  may  deflect  the  bicuspid  or  cause  it  to  rotate  more 
or  less  upon  its  axis,  being  favored  by  the  spongy  character  of 
the  alveolar  process  (Fig.  185). 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW.  337 

3.  The  forward  movement  of  the  molars  necessarily  dimin- 
ishes the  space  left  for  the  bicuspids  and  cuspids  and  when  the 
first  bicuspid  and  cuspid  erupt  before  the  second  bicuspid,  this 
may  be  crowded  out  of  its  proper  place. 

4.  A  rotation  of  a  bicuspid  from  a  want  of  proper  occlusion 
is  not  rare.  An  examination  of  the  grinding  surface  of  the  bicus- 
pid shows  that  it  is  designed  to  articulate  with  an  opposing 
tooth.  When  its  two  cusps  fail  to  find  an  opposing  cusp  to  keep 
them  in  place  its  function  is  lost  and  its  fixedness  of  position 
endangered. 

Frequently  more  than  one  of  these  causes  are  at  work  or 
one  implies  another.  Thus,  if  there  is  accord  between  the  size 
of  the  jaw  and  that  of  the  teeth,  some  of  the  local  causes  cannot 


Fig.  185 


arise ;  the  cuspid  may  erupt  before  the  second  bicuspid  with- 
out disarranging  the  arch  and  a  bicuspid  may  be  deflected  by  a 
deciduous  root  and  ultimately  move  into  place  unless  crowded 
upon  by  a  six-year  molar.  Rotation  may  be  the  result  of  a 
crowded  condition,  throwing  the  tooth  out  of  the  arch  when 
proper  occlusion  is  out  of  the  question. 

As  the  first  bicuspid  erupts  before  the  second  it  has  the 
advantage  of  such  space  as  there  is.  It  may  be  crowded  out  of 
place  by  the  forward  movement  of  the  six-year  molar  together 
with  the  premature  eruption  of  the  cuspid.  Permanent  deflec- 
tion due  to  the  retention  of  a  deciduous  root  is  out  of  the  ques- 
tion vvhen^ there  is  sufficient  space,  but  rotation  upon  its  axis  from 
want  of  proper  occlusion  may  occur  here  as  elsewhere. 

23 


338  IRREGULARITIES    OF    THE    TEETH. 

The  posterior  surface  of  the  bicuspid  touches  the  first  cuspid 
only  at  one  point,  being  an  angle  and  not  a  surface,  and  this  is 
a  fruitful  source  of  irregularity. 

Irregularities  first  attracted  attention  by  the  deformity  they 
produced,  not  by  their  interference  with  function.  Overcrowded 
anterior  portions  of  the  arch  and  displacement  of  individual 
teeth  were  noticed.  It  was  long  ere  the  results  of  injudicious 
extraction  were  observed.  The  first  permanent  molar  was  ruth- 
lessly destroyed  until  comparatively  recent  times,  producing  a 
large  proportion  of  irregularities  in  the  form  of  malocclusion. 
This  loss  of  function  was  produced  so  gradually  that  the  patient 
was  not  aware  of  it.  He  might  notice  inconvenience  in  mastica- 
tion, but  did  not  attribute  it  to  the  cause,  since  even  persons 
of  great  intelligence  know  but  little  about  occlusion  of  their 
teeth. 

This  tooth  has  hitherto  been  sacrificed  for  two  reasons: 
(i)  Its  early  decay,  brought  about  by  the  tax  upon  the  system 
of  the  growing  child  and  the  neglect  from  which  the  teeth  sufifer, 
particularly  during  the  period  of  its  development.  The  parent 
usually  did  not  know  of  its  existence  until  the  child  complained 
of  toothache.  (2)  It  has  been  extracted  to  correct  an  over- 
crowded arch. 

When  removed  to  stop  pain,  the  pain  is  indeed  relieved  by 
extraction,  but  leaves  in  its  train  many  evils.  When  removed 
to  correct  a  crowded  arch,  twice  as  much  space  is  gained  as 
desirable.  The  crowded  arch  is  not  relieved,  as  the  cuspid, 
because  of  the  length  and  strength  of  its  root,  remains  station- 
ary, while  the  bicuspids  move  back  singly  or  in  pairs,  leaving 
the  position  of  the  incisors  unchanged.  The  disastrous  effects  of 
extracting  the  first  molar  become  apparent  when  its  function  is 
understood. 

As  Dr.  J.  E.  Cravens,^  of  Indianapolis,  has  remarked,  "The 
first  permanent  molar  has  four  distinct  functions :  (i)  To  sup- 
ply additional  surface  for  mastication  when  development  has 
progressed  so  that  the  deciduous  molars,  unaided,  are  no  longer 
competent  to  meet  the  requirements  of  nature.  (2)  To  support 
the  crowns  of  the  deciduous  molars  when  they  have  become 

1  Annual  Universal  Medical  Science,  1888. 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW. 


339 


unstable,  because  of  absorption  of  their  roots  to  accommodate 
the  advance  of  their  immediate  successors — the  bicuspids — 
which  are  usually  erupted  between  the  ninth  and  the  eleventh 
years.  The  deciduous  molars  begin  to  loosen  six  to  twelve 
months  before  their  final  displacement.  Should  a  permanent 
first  molar  be  extracted  early — say  between  the  seventh  and 
eighth  years — the  "deciduous  molars  supported  by  it  would  loosen 
prematurely  so  as  to  be  unserviceable  for  mastication  and  per- 
haps be  lost  six  to  twelve  months  before  the  eruption  of  the 
succeeding  bicuspids.  (3)  To  guide  the  second  bicuspid  into 
position  in  event  of  a  loss  of  this  molar  previous  to  eruption 
of  the  second  bicuspid,  the  latter  is  liable  to  erupt  back  of  its 
true  position,  or  after  erupting  normally  to  float  backward  along 
the  ridge  of  the  gum,  inclining  posteriorly  in  such  a  manner  as 


ijifliijllliiiliiiiiiiiiiiliiiililliiiilliiiiiiiiijiilllljiiililiiiiljiiliillillH^ 


Fig.  186. 

seriously  to  impair  its  efifectiveness  as  a  masticating  organ.  This 
is  particularly  the  case  in  the  inferior  maxilla.  (4)  To  induce 
additional  development  of  the  horizontal  portion  of  the  lower 
jaw,  immediately  anterior  to  the  ramus,  in  order  to  make  easier 
the  eruption  of  the  permanent  second  molar  and  to  prevent  the 
well-known  tendency  of  the  latter  to  tip  forward,  thus  weakening 
the  support  of  its  roots  and  impairing  its  value  as  a  grinder. 

The  first  permanent  molar  is  supposed  by  many  observers  to 
exercise  an  important  influence  in  establishing  a  proper  angle  to 
the  inferior  maxilla.  If  such  idea  is  correct  (and  several  condi- 
tions indicate  that  it  is)  it  adds  possibly  another  to  the  already 
long  and  important  list  of  the  functions  pertaining  to  this 
tooth." 


340  ^  IRREGULARITIES    OF    THE    TEETH. 

The  wholesale  extraction  of  the  first  permanent  molar  in  the 
past,  no  doubt  arrested  development  of  the  alveolar  process  as 
well  as  of  the  maxillary  bones,  since  development  of  the  process 
and  jaws  depends  largely  on  the  function  of  the  teeth,  their  artic- 
ulation and  their  motion  stimulating  nutrition  and  enlarging  the 
arch. 

Some  dentists  with  a  skill  the  result  of  routine  rather 
than  knowledge,  are  still  extracting  four  sound  molars  without 
the  least  thought  of  the  consequences.  Such  a  one,  who  was 
practicing  in  a  southern  parish  not  many  years  ago,  was  in  the 
habit  of  taking  out  the  first  permanent  molar  in  every  instance. 
The  result  was,  he  claimed,  "that  all  the  people  in  that  part 
of  the  country  possessed  good,  regular  teeth  and  that  an  irregu- 
larity was  the  exception."  I  have  after  observed  the  want  of 
development  of  the  alveolar  process  and  sometimes  the  jaws 
from  the  extraction  of  those  teeth.  This  also  occurs  in  cases 
where  the  germ  has  not  developed  and  the  tooth  is  missing. 
More  marked  instances  are  those  where  three  or  four  germs 
are  wanting.  The  loss  of  a  tooth  performing  such  a  work  as 
the  first  permanent  molar  impairs  mastication  and  produces 
vicious  occlusion  and  is  detrimental  to  the  contour  of  the  face. 

When  extracted  before  the  second  molars  erupt,  one-half 
or  more  of  the  grinding  surface  of  the  teeth  is  lost.  The  nutri- 
tion of  the  patient  suffers  in  proportion  and  health  may  be 
seriously  impaired  because  of  inability  to  masticate  food  prop- 
erly. The  horizontal  portion  of  the  lower  jaw  is  but  imperfectly 
developed  because  function,  one  of  the  most  important  means 
of  development,  is  lost  and  insufficient  room  is  left  for  the  second 
and  third  molars. 

When  the  jaw  with  deciduous  teeth  is  compared  with  one 
having  permanent  teeth,  there  is  noticeable  a  difference  in  the 
length  of  the  rami  and  bodies,  and  a  still  greater  difference  in 
the  angles.  This  difference  results  from  the  gradual  separation 
near  the  angle  and  is  due  to  the  growth  of  the  molars.  The 
arches  of  the  permanent  set  are  separated  posteriorly  by  the 
eruption  of  the  first  permanent  molar.  When  these  molars  are 
lost  before  the  second  molars  are  in  place,  the  characteristic 
angle  of  the  jaw  becomes  less  marked.    The  loss  of  this  molar  on 


LOCAL    TEETH    IRREGULARITIES UPPER    JAW.  341 

one  side  only  will  produce  asymmetry  of  the  two  sides  of  the 
face,  noticeable  to  the  trained  eye  the  parallelism  of  the  two 
arches  having  been  disturbed.  If  the  two  be  lost  early  the  jaws 
approach  each  other  more  than  normally  near  the  angle,  throw- 
ing the  force  of  mastication  forward.  As  the  first  and  second 
bicuspids  do  not  erupt  until  the  tenth  or  eleventh  year,  and  the 
deciduous  molars  loosen  six  to  twelve  months  before  they  are 
displaced,  the  child  is  forced  to  masticate  its  food  for  several 
years  on  a  portion  of  the  arch  designed  for  other  purposes,  com- 
pelling these  teeth  to  perform  the  unnatural  function  of  grinding. 
This  confusion  of  functions  has  imperfect  results  and  changes 
the  facial  outline  of  the  face. 


^—  *G--s!£\  .^_i^    :  Fig.  187. 

As  the  first  permanent  molar  erupts  it  acts  as  a  fixed  point 
separating  and  holding  the  jaws  somewhat  throughout  their 
entire  extent  in  front,  as  well  so  as  to  make  room  for  the  grow- 
ing incisors.  The  deciduous  incisors  being  very  much  shorter 
than  the  permanent  ones,  necessarily  have  a  shorter  bite.  When 
the  first  permanent  molar  is  lost  the  natural  bite  is  shortened, 
for  this  molar  acts  as  a  force  which  lengthens  the  arches  back- 
ward and  also  separates  them  verticallv. 

When  this  tooth  is  lost  the  lower  permanent  incisors  as  they 
develop  strike  with  greater  force  against  the  upper  and  are 
carried  forward.  The  change  at  first  is  imperceptible,  but  in  the 
course  of  time  these  teeth  will  be  found  spreading  more  or  less 
like  a  fan.  Though  the  organic  relation  of  the  upper  and  lower 
jaw  is  not  apparent  at  first  as  that  of  other  organs  and  the  twq 


342 


IRREGULARITIES    OF    THE    TEETH. 


jaws  seem  to  enjoy  greater  independence,  proper  occlusion  is 
indispensable  to  their  health  and  the  teeth  in  the  lower  arch  are 
forced  out  of  their  sockets  by  a  deposit  of  osseous  material  not 
consumed  through  proper  function. 

Naturally  bicuspids  tend  to  move  forward  because  of  the 
inclination  of  the  root  and  the  angle  formed  by  the  two  jaws, 
which  makes  the  teeth  strike  at  an  angle  as  well.  This  tendency 
usually  prevents  them  from  moving  back,  even  if  the  first  molar 
is  extracted.  When  the  cusps  are  long  they  usually  retain  their 
natural  articulation,  but  sometimes,  as  has  been  pointed  out, 
they  move  backward.  They  may  move  back  separately  or 
may  drop  back  together  (Fig.  i86).  This  dropping  back  destioys 
the  articulation,   causing  the  opposing  teeth  to  strike  only  at 


Fig.  188. 


certain  points,  instead  of  bringing  surfaces  in  contact  and  fre- 
quently partial  rotation  upon  their  axes  results. 

The  most  ordinary  result  of  the  extraction  of  this  tooth,  as 
Dr.  Davenport^  has  shown,  is  the  forward  movement  of  the 
second  and  third  molars  (Fig.  187),  causing  these  to  tip  forward 
and  resulting  in  vicious  articulation.  Externally  the  articula- 
tion may  appear  not  to  have  sufifered,  but  when  it  is  examined 
inside  of  the  arch,  it  is  found  that  the  opposing  teeth  meet  only 
at  certain  points,  becoming  thereby  partially  useless.  Fig.  188 
shows  the  forward  movement  of  the  first  permanent  molar.  The 
temporary  molars  on  the  right  side  are  in  place,  thus  holding 


2  Dental  Cosmos,  July,  1887. 


LOCAL    TEETH    IRREGULARITIES — UPPER    JAW.  343 

the  first  permanent  molar  in  place;  while  on  the  left  side  the 
temporary  molars  have  been  extracted  and  the  first  molar  has 
moved  forward  one-fourth  of  an  inch.  The  force  of  mastication 
and  the  direction  of  the  roots,  together  with  the  eruption  of  the 
second  molar,  increases  this  tendency. 

Length  of  the  rami  body,  depth  of  sulci  of  masticating  sur- 
face and  local  irregularities  of  the  teeth  in  front,  may  so  modify 
the  occlusion  as  to  result  in  bilateral  asymmetry  and  the  degree 
of  tipping  forward  may  be  quite  unlike. 


CHAPTER    XXVII. 


LOCAL  CAUSES  OF  TEETH  IRREGULARITTES— 
LOWER  JAW. 

The  upper  and  lower  jaw  are,  as  already  pointed  out,  distinct 
in  character,  function  and  course  of  development. 

The  upper  jaw,  when  normal,  describes  a  portion  of  a  lareei 
circle,  the  teeth  overlapping  those  of  the  lower.  It  is  fixed  nnd 
depends  for  its  function  on  the  activity  of  the  lower.  Owing 
to  this  immobility,  irregularities  are  more  markedly  constitu- 
tional in  type.  Thus,  the  various  abnormal  arches  not  seen  in 
the  lower,  the  high  and  narrow  vault  and  the  inward  curvature 

1 


Fig.  189. 


iig.    i!JU. 


of  the  alveolar  processes  occur.  The  upper  jaw  has  a  greater 
sweep  of  development  and  consequently  greater  possibility  of 
irregularity  in  its  anterior  columns  as  these  are  unrestricted. 
The  lower  is  restrained  by  the  overlapping  of  the  upper  teeth. 
The  lower  jaw  is  hung  loosely,  but  firmly  by  its  condyles,  permit- 
ting motion  in  three  directions — antero-posterior,  vertical  and 
lateral. 

In  Fig.  189,  the  six  anterior  inferior  incisors  are  shown.  The 
points  of  contact  are  at  their  cutting  edges,  the  mesial  and  distal 
surfaces  being  rounded  which  enables  them  to  crowd  easily  past 
each  other  when  force  is  applied.  The  roots  are  flattened  at 
their  sides,  so  that  when  pressure  is  brought  to  bear  upon  them 
they  move  with  readiness  over  a  considerable  distance.  That 
pressure  cannot  well  be  exerted  in  a  straight  line  through  the 
posterior  column  and  from  thence  extend  in  a  curve  through  the 

344 


LOCAL    TEETH    IRREGULARITIES — LOWER    JAW. 


345 


anterior  teeth,  from  the  law  of  simple  forces,  which  act  in  straight 
lines  only.  The  cuspid,  finding  no  resistance  in  front,  but  being 
resisted  by  the  incisors  slightly  at  the  side,  necessarily  pass  for- 
ward. The  lateral  is  too  weak  to  afTord  resistance.  Even  if  the 
centrals  could  be  acted  upon  by  the  pressure  from  behind,  they 
would  not  be  prevented  from  assuming  a  V-shape  by  the  over- 
lapping incisors  above,  since  the  more  the  upper  arch  is  com- 
pressed laterally  and  the  mesial  angle  of  the  central  is  turned  out- 
ward, the  more  will  the  distal  angle  be  turned  inward,  and  thus 
confine  the  lower  incisors. 

The  narrowness  of  the  lower  incisors  as  compared  with  the 
upper  favors  this  tendency.  These  conditions  are  necessarily 
modified  by  the  local  peculiarities  of  the  upper  arch,  relative 


i'lK.   I'.tl. 


tig.   11« 


str?!-!gth  of  teeth  and  nature  of  occlusion  being  all  important 
factors  in  determining  final  results. 

In  Fig.  190  is  a  normal  lower  maxilla.  The  line  a  b,  passing 
through  the  cuspids,  bicu?''Ids  and  molars,  shows  the  direction 
of  the  force  exerted  by  t'he  posterior  column  upon  the  anterior. 
For  growth  the  lower  jaw  depends  far  more  upon  function  than 
the  upper.  Tl  e  growth  of  the  lower  jaw  is  limited  to  the  pos- 
terior coluiiMi.  This  is  accomplished  by  absorption  of  the 
aniero-posterior  border.  The  freedom  of  motion  is  retarded 
by  the  arch  of  the  upper,  for  which  reason  irregularities  are 
much  rarer  in  the  lower  than  the  upper  jaw,  since  overlapping 
of  the  upper  teeth  tends  to  correct  predisposition  to  mal  arrange- 
ment. 

Irregularities  of  the  lower  jaw  result  more  from  local  causes 
than  those  of  the  upper  except  such  as  are  found  in  the  under- 
hung jaw.     Its  development   depends  largely  on  mastication. 


346 


IRREGULARITIES    OF    THE    TEETH. 


Owing  to  its  movements  there  are  fewer  irregularities  in  this 
maxilla  and  the  jaw  is  more  apt  to  be  normal.  Irregularities 
back  of  the  cuspids  are  very  rare.  Occasional  contractions  of 
the  lower  arch  occur,  dipping  in,  is  due  to  peculiarities  of  occlu- 
sion. When  cases  of  irregularity  exist,  they  are  generally  found 
in  mouths,  the  lower  arch  of  which  exceeds  the  upper  in  diam- 
eter, thus  permitting  less  firm  interlocking  and  greater  freedom 
of  individual  teeth. 

When  the  diameter  of  the  -circle  of  the  teeth  of  the  lower  jaw 
exceeds  that  of  the  upper,  its  lateral  movement  causes  an 
enlargement  of  the  upper  circle  by  opening  the  median  suture, 
this  condition  being  indicated  by  the  spreading  of  the  superior 
central  incisors.  As  has  been  shown  in  the  chapter  on  migration 
of  teeth,  twisted  bicuspids  often  result  from  entire  want  of  occlu- 


Fig.  193.  Fig.  194. 

sion,  or  the  touching  of  two  opposing  teeth  at  only  one  point. 
The  most  frequent  form  of  irregularity  is  a  crowding  of  the 
incisors.  This  is  generally  the  case  where  the  size  of  the  teeth , 
and  the  jaw  are  not  in  harmony.  It  is  due  to  two  causes :  (i) 
The  teeth  of  the  lower  jaw  are  forced  inward  by  occlusion,  the 
diameter  of  the  circle  of  the  upper  teeth  being  usually  the 
smaller ;  (2)  The  forward  movement  of  the  posterior  column. 

The  two  halves  of  tlie  lower  arch,  like  those  of  the  upper 
for  obvious  reasons  do  not  present  the  same  forms  of  irregu- 
larity. Like  the  upper  jaw,  the  lower  is  subject  to  forward 
movement  of  the  posterior  column.  A  want  of  harmony  in  the 
development  of  upper  and  lower  maxillae  produces  a  crowded 
condition  of  the  lower  arch,  resulting  in  pressure  upon  the 
anterior  column. 


LOCAL    TKETH    IRREGULARITIKS LOWER    JAW. 


347 


The  direction  of  the  roots  of  the  lower  molars  greatly 
increases  this  tendency.  When  the  crowns  of  the  second  and 
third  molars  are  erupted,  the  first  molar  is  pushed  forward.  The 
pressure  is  exerted  principally  through  the  posterior  column 
upon  the  cuspid  and  is  in  a  straight  line.  This  tooth,  by  virtue  of 
its  rounded  cusp,  slips  by  the  lateral  and  is  projected  forward 
often  beyond  the  central  incisors,  leaving  the  lateral  behind. 

Like  the  upper  maxillae  the  two  halves  of  the  alveolar  arch 
are  separate  and  are  modified  independently.  An  irregularity 
on  one  side  by  no  means  indicates  a  similar  irregularity  on  the 
other,  owing  to  the  difference  of  pressure  that  may  be  exerted. 

In  Fig.  191  the  left  dental  arch  is  seen  to  be  normal,  but  the 


Fig.  195. 

forward  movement  of  the  posterior  column  has  caused  the  right 
lateral  to  fall  behind.  As  the  two  columns  converge  anteriorly 
they  exert  their  pressure  in  this  direction,  in  consequence  irregu- 
larities of  the  lower  jaw  are  confined  for  the  most  part  to  the 
region  of  the  incisors. 

Though  the  laterals  are  generally  pressed  within,  while  the 
centrals  occupy  their  usual  position,  these  teeth  may  stand  at 
various  angles  determined  by  local  peculiarities  of  the  teeth  of 
the  upper  maxilla.  Thus  it  may  happen  that  a  cuspid  or  a  lateral 
may  strike  outside  of  its  antagonist  of  the  opposite  jaw. 

In  Fig.  192  a  common  form  of  irregularity,  in  which  both 
posterior  columns  have  moved  forward.  The  laterals  are 
crowded  backward  and  inward.  The  lines  of  force  are  also 
directed  inward,  but  a  V-shaped  arch  is  prevented  by  the  lower 


348  IRREGULARITIES    OF    THE    TEETH. 

centrals  striking  against  the  palatal  surfaces  of  the  upper  cen- 
trals. If  the  cause  of  this  form  of  irregularity  be  borne  in  mind 
it  will  be  understood  why  extraction  of  a  lower  lateral  or  central 
renders  this  irregularity  worse,  inasmuch  as  it  disarranges  ccclu- 
sion  of  the  cuspids. 

In  Fig.  193  the  right  dental  arch  is  normal.  The  left  posterior 
column  has  pushed  against  the  lateral  and,  meeting  with  sufficient 
resistance,  the  central  is  carried  backward.  While  erupting, 
the  central  was  carried  inward,  owing  to  a  want  of  harmony  of 
development.  Two  centrals  have  been  found  directed  inward, 
though  this  form  of  irregularity  is  rare. 

In  Fig.  194  the  left  dental  arch  is  normal.  The  forward 
movement  of  the  posterior  column  on  the  right  side  has  caused 
the  cuspid  to  advance  beyond  the  line  of  the  incisors.  The 
rotation  of  the  cuspid  upon  its  axis  caused  it  to  pass  by  the 


Fig.  196. 

lateral,  leaving  it  in  position.  This  is  a  common  form  of  irregu- 
larity. Occasionally  the  cuspid  is  carried  forward  in  the  direction 
of  the  pressure.  Such  a  case  is  illustrated  in  Fig.  195.  The  left 
lateral  has  been  carried  inward  in  the  manner  already  described. 
The  posterior  column  has  pushed  the  cuspid  on  the  right  side 
laterally  so  that  it  occupies  the  position  of  the  right  lateral  and 
the  bicuspid  is  carried  forward  and  outside  of  the  arch. 

The  cuspid  erupts  in  line  with  the  other  anterior  teeth  unlike 
the  upper,  the  crypt  of  which  is  above  and  outside  of  the  lateral 
incisor  and  bicuspids.  For  this  reason  and  the  fact  that  the 
upper  cuspid  tends  to  keep  it  in  position  by  occlusion,  irregu- 
larities of  the  cuspid  of  the  lower  jaw  are  not  so  common  as 
those  of  the  upper.  When  the  tooth  is  found  out  of  line,  it  is 
anterior  to  its  normal  position — rarely,  if  ever,  posterior.  Its 
eruption  may  be  tardy,  giving  the  advantage  ot  time  to  the  upper 
cuspid  and  directing  the  lower  cuspid  outward.  In  a  crowded 
jaw,  disarrangement  pf  the  incisors  ma^  follow,  leaving  th^ 


LOCAL    TEETH    IRREGULARITIES — LOWER    JAW. 


349 


lateral  almost  directly  behind  the  cuspid,  as  in  Fig.  195.  When 
there  is  malposition  of  the  cuspid  on  one  side  of  the  maxilla, 
the  cuspid  of  the  opposite  is  usually  pushed  forward,  as  seen 
in  the  same  illustration. 

Owing  to  malposition  of  the  germ,  the  cuspid  may  be 
found  outside  of  the  incisors  in  the  median  line  (Fig.  196),  or 
even  inside  of  the  arch  (Fig.  197).  Rarely  it  is  found  on  the 
median  line  between  the  incisors,  as  shown  in  this  illustration. 

Like  the  cuspid,  the  position  of  the  bicuspid  is  most  fre- 
quently afifected  by  the  forward  movement  of  the  posterior  col- 
umns. Irregularity  in  a  lateral  direction  is  rare,  since  density 
of  the  lower  maxilla  is  unfavorable. 

If  a  bicuspid  be  found  without  or  within  the  arch,  its  position 
is  due  to  undue  retention  of  the  temporary  teeth.     In  Fig.  198 


Fig.  197. 

the  second  bicuspid  is  situated  inside  the  arch,  while  in  Fig.  199 
the  first  bicuspid  is  inside  and  the  second  bicuspid  outside  of 
the  arch.  Twisted  bicuspids  occur  frequently  from  want  of 
proper  occlusion,  when  the  space  yielded  by  the  lower  jaw  is 
larger  than  that  of  the  upper,  or  when  the  first  molar  is  extracted. 

When  the  second  temporary  molar  is  retained  too  long,  the 
first  permanent  molar  may  be  pushed  forward,  thus  confining 
the  bicuspid  and  preventing  it  from  erupting. 

That  teeth  move  when  acted  upon  by  external  force  is  well- 
known,  and  the  fact  is  utilized  in  operations  for  producing  tem- 
porary separations  in  regulating  and  the  like.  Why  they  should 
move  from  their  normal  positions  without  any  apparent  cause 
is  not  very  easy  to  explain.  When  the  arch  of  the  alveolar  process 
is  greater  than  that  of  the  combined  diameters  of  the  teeth, 
there  must  be  space  or  spaces  somewhere.  This  space  is  usually 
equally  distributed  among  the  anterior  teeth.    Sometimes,  how- 


350  IRREGULARITIES    OF    THE    TEETH.l 

ever,  spaces  are  found  that  disfigure  the  mouth  and  besides  one 
or  more  teeth  appear  to  have  rotated  upon  their  axes. 

These  motions  are  best  considered  under  two  heads :  (A) 
Perfect  occlusion ;  (B)  proper  relation  between  waste  and  repair. 

(A)  If  the  occlusion  of  the  teeth  be  perfect,  so  that  each 
tooth  is  kept  in  place  by  its  adjoining  neighbors  and  the  opposing 
tooth,  dislodgment  is  impossible.  Each  tooth  should  touch 
that  adjoining  them  at  the  extremities  of  their  greatest  diameters. 
This  allows  a  slight  lateral  motion. 

Good  occlusion  differs  according  to  the  function  of  different 
teeth.  The  upper  and  lower  incisors  overlap  each  other,  pro- 
ducing what  is  termed  the  overbite.  In  the  normal  relation 
they  strike  in  a  straight  line,  which  passes  through  their  roots. 


Fig.  108. 

The  curved  lingual  surface  of  the  upper  incisors  allows  for  their 
sliding  into  this  position.  The  force  being  thus  exerted  in 
straight  lines  there  is  constant  tendency  to  keep  them  in  position 
and  as  the  pressure  is  upward  and  downward  vertical  spread- 
ing of  the  upper  incisors  is  impossible.  The  relation  of  cuspids 
is  similar.  Quite  otherwise  with  bicuspids  and  molars.  Begin- 
ning with  the  bicuspids  the  cusps  of  the  first  superior  bicuspid 
are  found  striking  not  over  that  of  the  first  lower  bicuspid  alone, 
but  over  the  angles  formed  by  the  distal  side  of  the  first  lower 
and  mesial  side  of  the  second.  Each  tooth  beginning  at  this 
point  is  not  only  in  relation  to  one  below,  but  to  two.  When 
one  of  these  teeth  is  extracted  the  order  of  the  mouth  is  dis- 
turbed and  r'  arrangement  of  some  kind  usually  follows.  What 
this  will  be  diipends  on  a  variety  of  circumstances. 


LOCAL    TEETH    IRREGULARITIES — LOWER    JAW. 


351 


A  typical  example  is  furnished  by  the  extraction  of  the  first 
molar.  The  forward  movement  of  the  second  molar  follows 
as  a  consequence.  A  tilting  forward  of  this  tooth  results.  The 
reason  for  this  is  obvious.  The  posterior  cusp  of  the  first  upper 
molar  strikes  the  anterior  cusp  of  the  second  lower  and  exerts 
its  whole  force,  which  was  meant  to  be  distributed  on  both  cusps. 

(B)  The  position  of  the  teeth  alone  does  not  determine  the 
relative  size  of  the  maxillae  and  the  occlusion  of  the  teeth.  Nutri- 
tion and  absorption,  waste  and  repair  play  an  important  part. 
On  perfect  harmony  of  these,  beauty  and  health  of  the  teeth 
depend.  Changes  in  the  position  and  removal  of  bone-cells  con- 
stantly vary  with  age  and  other  physical  conditions  of  the  patient. 


Fig.  I'.iO. 


This  disposition  and  removal  of  bone-cells  is  seen  in  the  changes 
that  the  lower  maxillse  undergo  during  the  different  periods  of 
life.  When  the  deciduous  teeth  are  replaced  by  the  permanent 
ones,  the  arch  of  the  jaw  becomes  more  pronounced  and  there 
is  a  lengthening  of  the  alveolar  ridge  backward  to  accommodate 
the  molars.  When  the  senile  changes  take  place  the  angle  of  the 
jaw  becomes  more  obtuse.  That  there  is  a  similar  adjustment 
to  circumstances  going  on  constantly  is  proven  by  circumstances. 
Correction  of  irregularities  depends  on  this.  The  position  of 
the  teeth  in  the  alveoli  is  determined  solely  by  the  tissues  around 
it.  By  producing  a  pressure  in  a  given  direction  bone-cells  may 
be  removed  on  one  side  and  others  deposited  on  the  other,  and 
the  position  of  the  tooth  changed.    The  change  in  the  deposit 


352 


IRREGULARITIES    OF    THE    TEETH. 


and  removal  of  osseous  matter  is  not  unlike  that  of  the  deposit 
of  particles  of  earth  in  the  bed  of  a  river,  where  stakes  have  been 
placed  for  the  purpose  of  locating  the  bed  of  the  river.  By 
successive  deposit  and  removal  of  these  particles  the  position  of 
these  may  be  changed  and  even  the  current  of  the  river.  Similar 
changes  in  the  contour  and  density  of  the  alveolar  processes 
occur,  depending  on  the  changes  of  blood  supply  and  absorption. 
Irritation  may  thus  stimulate  the  activity  of  the  capillaries  to  a 
more  than  ordinary  degree  of  repair. 

Every  tooth  exerts  a  pressure  of  its  own  in  different  direc- 
tions. Were  this  not  so  it  would  be  dilificult  to  account  for  the 
elongation  of  a  tooth  when  its  opponent  is  extracted.    This  pres- 


sure is  healthy  and  implies  the  antagonism  of  opposing  teeth. 
If  this  occlusion  is  wanting,  the  relation  of  waste  and  repair  is 
disturbed.     Excess  of  bone-cells  is  often  deposited  as  a  result. 

When  these  two  fundamental  laws  of  good  occlusion  and 
balanced  waste  and  repair  are  violated,  one  of  the  three  following 
conditions  follows:  i.  Movement  of  individual  teeth  in  straight 
lines.  2.  Rotation  of  individual  teeth  upon  their  axes.  3.  For- 
ward movement  of  groups  of  teeth  and  the  alveolar  processes 
supporting  them. 

When  alveolar  processes  and  teeth  correspond  in  size  and 
the  occlusion  is  good,  as  already  stated,  spaces  between  the  teeth 
are  out  of  the  question.  Sometimes  a  space  is  found  between 
the  central  incisors.  If  the  occlusion  be  good  otherwise,  this 
space  is  due  to  continuance  of  growth  at  the   margin  of  the 


LOCAL    TEETH    IRREGL^LARITIES — LOWER    JAW. 


353 


suture.  There  is  a  greater  deposit  of  osseous  material  than  is 
needed,  producing  a  larger  diameter  of  the  jaw  than  the  teeth. 
This  begins,  usually,  at  an  early  period  in  life  and  continues  till 
the  growth  of  the  osseous  system  has  ceased.  As  the  jaw  devel- 
ops in  the  child  while  the  temporary  teeth  remain,  it  is  but 
natural  that  spaces  should  be  formed  in  time  until  the  permanent 
teeth  take  their  place. 

Spaces  may  be  artificially  created  gradually  by  forcible  separ- 
ation by  wedges.  In  former  years,  when  more  force  was  applied 
by  dentists,  irritation  was  created  and  absorption  on  one  side 
induced.  In  this  way  several  teeth  were  sometimes  crowded  in 
one  direction.  When  the  anterior  incisors  do  not  strike  on  a 
line,  but  at  an  angle  so  that  the  cutting-edges  of  the  lower 
incisors  strike  against  the  inclined  plane  of  the  lingual  surface  of 


Fig.  201. 

the  upper  incisors,  outward  pressure  is  exerted  and  the  incisors 
separate.  The  spaces  so  frequently  seen  in  the  permanent 
incisors  in  children  are  produced  by  tardy  eruption  of  the 
cuspids.  When  the  cuspids  come  down  into  place  these  spaces 
disappear.  Spaces  are  rarely,  if  ever,  observed  between  molars. 
Again,  the  lower  jaw,  if  too  large  for  the  upper  jaw,  may  act 
as  a  wedge  and  by  striking  against  it  may  spread  the  central 
suture.  The  spaces  between  these  teeth  are  usually  found  to  be 
healthy.  It  is  not  reasonable  to  suppose  that  either  salivary 
or  germinal  calculus  or  inflamed  gums  could  produce  this 
motion.  Were  the  pressure  exerted  on  one  side  only  there 
might  appear  to  be  some  ground  for  this  supposition,  providing 
the  calculus  exerted  a  pressure  too  great  for  the  rest  of  the 
teeth  to  resist.  But  when  calculus  is  deposited  on  both  sides 
the  pressure  exerted  would  be  counter-balanced  and  lateral 
motion  could  not  take  place.    Those  who  hold  this  opinion  are 

24 


354  IRREGULARITIES    OF    THE    TEETH. 

probably  misled  by  the  fact  that  a  tooth  may  be  dislodged  by 
calculus  from  its  socket  vertically.  In  this  case  the  calculus 
diminishes  the  diameter  of  the  socket  and  the  wedge-shaped  root 
is  forced  out. 

When  a  tooth  touches  its  opposites  only  at  one  point,  or  the 
opposing  tooth  was  extracted  as  it  frequently  happens  with 
bicuspids,  instead  of  articulating  with  surfaces,  rotation  may 
result.  In  this  case  bone-cells  are  deposited  on  one  side,  while 
those  at  an  angle  with  these  are  removed.  This  produces  a 
slight  rotation  which  twists  the  tooth.  That  this  process  is  physi- 
ologic is  proven  by  the  healthy  state  of  the  gums  and  alveolus, 
which  is  found  in  most  of  these  cases.  In  Fig.  200  is  seen  not 
only  the  rotary  motion  to  the  bicuspids,  but  also  spontaneous 
motion  in  direct  lines — a  condition  frequently  observed. 

In  young  persons  when  the  blood  supply  is  rich  with  nutri- 


tious  material  and  when  waste  and  repair  go  on  rapidly,  four 
and  sometimes  six  anterior  teeth  and  alveolar  processes  are  car- 
ried forward.  This  proper  occlusion  with  the  inferior  incisors 
becomes  impossible.  These  become  elongated,  and,  failing  to 
find  support  in  the  upper  incisors,  strike  against  the  roof  of  the 
mouth.  Irritation  is  produced  and  an  excessive  flow  of  blood 
to  the  parts  follows. 

One  of  the  most  interesting  forms  of  irregularity  thus  result- 
ing, is  that  in  which  the  inferior  incisors  impinge  upon  the 
mucous  membrane  of  the  mouth  and  the  superior  centrals, 
laterals,  cuspids  and  bicuspids,  having  moved  forward,  project 
to  such  an  extent  that  the  upper  lip  cannot  close  over  them. 

These  cases,  while  found  in  normal  individuals,  occur  also 
among  idiots,  deaf-mvites,  the  blind  and  insane.  The  deformity, 
not  seen  in  temporary  teeth,  is  confined  to  the  permanent  set, 
beginning  at  the  seventh  or  eighth  year  and  increasing  with  age. 


LOCAL    TEETH    IRREGULARITIES — LOWER    JAW. 


355 


When  not  corrected  the  teeth  will  finally  project  at  an  obtuse 
angle.  In  a  woman  fifty-five  or  sixty  years  of  age  the  teeth  will 
project  almost  horizontally.  The  vault  connected  with  this 
irregularity,  usually  low,  is  sometimes  high.  In  this  case  it  is 
more  pronounced;  just  as  V  and  saddle-shaped  arches  are  more 
pronounced  when  associated  with  a  high  vault.  Irregularity 
begins  at  the  central  incisors,  extending  backward.  Generally 
later  in  life  tartar  collects  around  the  roots  and  interstitial  gingi- 
vitis sets  in,  exaggerating  the  condition. 

In  the  majority  of  cases  the  superior  maxilla  is  arrested.  The 
teeth  project  at  an  angle  of  20  degrees,  carrying  the  alveolar 
process  wnth  them  so  that  they  strike  over  the  lower  incisors. 

Dr.  Kingsley  (who  first  described  this  form  of  irregularity) 
correctly  claimed  that  this  condition  is  neither  inherited  nor  the 


Fig.  303. 

result  of  thumb-sucking.  The  conditions  under  which  this 
irregularity  is  brought  about  are  both  constitutional  and  local. 
Excessive  proliferation  of  bone-cells  does  not  begin  before  the 
sixth  or  seventh  year,  hence,  not  until  the  permanent  teeth  are 
erupted.  A  want  of  balance  of  nervous  function,  resulting  from 
neurotic  conditions  or  a  transmitted  tendency  to  disease,  may 
interfere  with  the  centers  of  ossification.  This  interference,  as  has 
been  shown,  frequently  finds  expression  in  the  anterior  part  of 
the  mouth,  sometimes  producing  a  high  vault,  contracted  arches, 
excessive  or  deficient  deposition  of  bone-cells.  The  conditions 
are  mostlv  confined  to  neurotics  and  degenerates.  Excessive 
proliferation  of  bone-cells  near  the  median  line  of  the  superior 
alveolar  process  tilts  the  axes  of  the  erupting  centrals  slightly 
outward.     This  direction  once  being  given  to  them,  when  the 


356 


IRREGULARITIES    OF    THE    TEETH. 


lower  incisors  strike  against  them  they  do  not  find  resistance  of 
correct  occlusion,  but  act  as  upon  an  inclined  plane,  throwing 
them  out  more  and  more  during  the  process  of  eruption.  This 
must  necessarily  terminate  in  striking  the  process  itself ;  the 
increased  activity  of  nutrition  which  irritation  sets  up  results  in 
excessive  development,  which  in  itself  is  an  evidence  of  degen- 
eracy. The  tilting  forward  of  the  upper  incisors  increases  the 
distance  between  them,  and  the  lower  incisors  do  not  find  the 
resistance  belonging  to  natural  function.  The  consequence  is 
the  elongation  of  the  lower  anterior  alveolar  arch.  Eruption  of 
the  first  permanent  molars  determines  the  relation  of  the  jaws  to 
each  other.     Occasionally,  however,  they  do  not  develop  their 


Fig.  204. 

full  length.  In  either  case  the  lower  incisors  strike  against  the 
mucous  membrane  of  the  roof  of  the  mouth,  which  constant 
irritation  stimulates  deposition  of  the  bone-cells  in  the  process. 
Were  occlusion  correct,  constant  pressure  on  the  roots  of  the 
teeth  would,  in  part,  conterbalance  excessive  deposit  by  waste. 
As  it  is,  the  roots  of  the  upper  incisors  form  an  angle  with  the 
cutting-edge  of  the  lower  teeth  and  as  the  mouth  opens  and 
closes,  the  force  of  the  lower  incisors  is  not  only  spent  on  the 
superior  process,  but  also  through  it  on  the  roots  of  the  upper 
teeth,  forcing  them  out  more  and  more.  In  Fig.  201  is  seen 
the  starting-point.  The  central  incisors  have  just  commenced 
to  move  forward,  in  the  mouth  of  a  girl  eleven  years  of  age. 


LOCAL    TEETH    IRREGULARITIES — LOWER    JAW.  357 

The  trouble  is  extended  to  the  neighboring  teeth  from  the  nature 
of  the  occhision.  In  Fig.  202  the  incisors  and  alveolar  process 
are  seen  carried  forward  by  excessive  deposition  of  bone-cells. 
By  action  of  the  lower  lip,  which  cannot  close  over  the  cutting- 
edges  of  the  upper  teeth,  but  soon  gets  between  the  superior  and 
inferior  incisors,  the  former  are  pressed  out  still  more.  Fig.  203 
shows  a  side  view  of  this  irregularity.  In  Fig.  204  is  seen  a 
remarkable  migration  of  the  molars. 

Want  of  fimction  encourages  deposit  of  lime  salts  around  the 
roots  of  the  teeth,  inducing  interstitial  gingivitis  later  in  life 
and  loosening  the  teeth. 

A  common  dental  irregularity  resultant  on  extraction  is  elon- 
gation of  the  teeth  on  the  opposite  jaw  (Fig.  203).  To  remain 
in  position  and  to  retain  a  healthy  alveolar  process,  teeth  must 
have  resistance  power.  If  two  teeth  be  extracted  upon  one  jaw, 
in  tooth  or  teeth  on  the  opposite  there  is  no  occlusion  when 
the  jaws  are  closed.  In  a  sense  these  teeth  become  foreign 
bodies.  In  reality  they  come  under  the  suppressive  economy 
of  growth  (loss  of  the  function  of  mastication).  Owing  to  tran- 
sitory nature  of  the  alveolar  process,  interstitial  gingivitis  sets 
in  and  about  the  roots  of  the  teeth. 

Deposition  and  absorption  of  bone  results  from  both  normal 
processes  (as  in  development  of  the  skeleton)  and  from  irrita- 
tions (the  deposition  and  absorption  of  bone  about  a  fracture). 
Inflammation  in  the  alveolar  process  about  the  root  or  roots  of 
the  teeth  under  favorable  conditions  likewise  build  up  or  absorb 
the  alveolar  process.  Bone  building  produces  lengthening  of  the 
teeth.  Interstitial  gingivitis  frequently  becomes  permanent. 
Pyorrhoea  ensues  with  deposits  upon  the  roots  as  a  result  of 
bone  absorption. 


CHAPTER    XXVIII. 


LOCAL  CAUSES  OF  TEETH  IRREGULARITIES— 
FINGER-SUCKING. 

Elsewhere  reasons  have  been  given  why  the  high  vault  and 
the  V  and  saddle-shaped  arches  cannot  be  ascribed  indiscrimin- 
ately to  thumb-sucking,  as  has  been  the  custom. 

The  greatest  confusion  of  ideas  has  been  current  among 
practitioners  as  to  the  etiologic  differentiation  of  these  cases. 
The  conditions  due  to  thumb-sucking  should  be  so  described 
that  the  student  is  aided  in  making  a  diagnosis.  In  cases  of 
irregularities,  due  to  thumb-sucking,  several  teeth  and  the  alveo- 
lar process  are  often  brought  forward.  Frequently  spaces  are 
found  between  them  so  that  they  stand  out  more  and  more  fan- 
shaped.     The  vault,  while  it  may  be  high,  is  usually  low.     The 


Fig.  205. 


teeth  are  frequently  aflfected  only  on  one  side,  the  shape  and 
extent  depending  upon  the  direction  of  the  force  and  the  hand 
employed  in  sucking.  In  the  V-shaped  arch  the  teeth  are  crowded 
and  point  toward  the  center,  owing  to  a  force  applied  by  the 
posterior  column  and  spent  on  both  halves  toward  the  median 
line.  The  vault  may  or  may  not  be  arched.  In  the  saddle- 
shaped  arch  the  teeth  are  crowded,  except  in  cases  due  to  hyper- 
trophy, and  they  stand  perpendicular.  The  vault  may  be  high 
or  low.  In  cases  of  thumb-sucking,  the  teeth  of  the  inferior 
maxilla  do  not  articulate  properly  with  the  upper  and  are  often 
turned  inward,  which  is  caused  by  the  pressure  of  the  thumb 
upon  the  cutting-edges.  The  distinguishing  feature  of  a  case  of 
thumb-sucking,  therefore,  is  the  spreading  of  all  or  a  part  of 
the  anterior  teeth  and  the  lower  teeth  usually  turned  inwards. 

358 


LOCAL    CAUSES    OV    TEETH    IRREGULARITIES. 


359 


\\'hen  the  vault  is  high  it  may  be  quite  marked  in  the  anterior 
portion  of  the  roof  of  the  mouth.  This  is  by  no  means  a  char- 
acteristic feature.  As  the  habit  of  thumb-sucking  usually  ter- 
minates before  eruption  of  the  permanent  teeth,  cases  of  irregu- 
larities resulting  in  children  over  ten  years  of  age  are  rare. 

Infants  usually  commence  to  suck  their  fingers  within  a  few 
hours  after  birth — in  the  majority  of  cases  not  later  than  the 
first  week.  The  habit  is  therefore  well  fixed  before  the  tem- 
porary teeth  begin  to  erupt.  This  being  the  case,  the  teeth  and 
the  alveolar  process  are  naturally  afifected  in  their  development 
if  the  pressure  is  continuous.  The  extent,  shape  and  location 
of  the  irregularity  depends  upon  the  hand  employed  and  the 
position  of  the  thumb  and  finger  used.    The  right  or  left  side  are 


afifected  according  to  the  hand  used,  though  occasionally  it  is 
found  in  the  median  line. 

As  the  child  usually  discontinues  the  habit  before  the  time 
of  the  eruption  of  the  permanent  teeth,  deformities  produced  by 
thumb-sucking  are  usually  confined  to  the  temporary  set. 

In  Fig.  205  is  shown  the  forward  movement  of  the  right 
central  and  lateral  incisor.  The  model  was  taken  from  an  impres- 
sion of  the  teeth  of  a  little  girl  two  and  a  half  years  of  age.  While 
in  the  act  of  sucking,  the  right  arm  rested  upon  the  breast  and 
the  ball  of  the  thumb  was  directed  against  the  palatine  surfaces 
of  the  incisors  which  were  carried  forward.  The  child  discontin- 
ued the  habit  at  four.  \Miile  the  cutting-edges  of  the  teeth  have 
been  slightly  pressed  forward  and  a  very  slight  impression  has 
been  made  on  the  alveolar  process,  none  was  made  on  the  roots 


360 


IRREGULARITIES    OF    THE    TEETH. 


of  the  teeth  and  consequently  no  deformity  exists  where  the 
germs  of  the  permanent  teeth  are  located.  After  the  child  dis- 
continued the  habit,  the  teeth  soon  returned  to  their  natural 
position,  aided  by  the  pressure  from  the  lip.  At  this  age  absorp- 
tion and  deposition  of  bone-cells  is  so  active  that  very  marked 
deformities  are  frequently  corrected  before  the  temporary  teeth 
are  lost,  providing  the  habit  ceases  in  infancy. 

In  Fig.  206  is  seen  quite  a  different  deformity.  Here  the 
teeth  are  fully  developed,  but  a  marked  deformity  existing  at 
the  median  line.  This  case  is  that  of  a  child  six  years  of  age. 
The  thumb  was  held  in  the  mouth  so  that  the  teeth  came  in 
contact  with  the  thumb  at  right  angles,  preventing  the  develop- 


ment of  the  alveolar  process.  The  teeth  of  the  inferior  maxilla 
do  not  articulate  properly  with  those  of  the  superior.  This  lack 
of  proper  articulation  is  caused  by  the  thumb  having  rotated 
upon  the  lower  teeth  after  the  upper  had  closed  upon  them. 
The  hard  palate  was  flat  and  normal,  hence  the  pressure  was 
direct  upon  the  teeth  and  the  thumb  did  not  come  in  contact 
with  the  tissues  of  the  mouth.  When  the  habit  continues  dur- 
ing the  development  of  the  permanent  set,  the  deformity  is  more 
marked  because  there  is  more  leverage,  as  is  shown  in  Fig.  207. 
In  the  case  illustrated  the  palate  is  flat  and  normal,  showing  the 
pressure  was  direct  upon  the  teeth  and  the  thumb  did  not  come 
in  contact  with  the  tissues  of  the  mouth.    The  superior  jaw  and 


I.OCAT,    CAUSES    OF    TEETH    IRREGULARITIES. 


361 


teeth  are  brought  forward  by  absorption  and  deposition  of  bone- 
cells,  and  the  lower  teeth  and  jaw  are  carried  inward. 

These  cases  arc  so  unlike  those  of  any  other  form  of  irregu- 
larity of  the  permanent  set  it  would  seem  impossible  to  over- 
look the  cause.  The  alveolar  process  and  teeth  assume  the  shape 
of  the  object  or  thing  sucked. 

In  Fig.  208  is  shown  the  front  view  of  a  case  of  thumb- 
sucking.    The  teeth  have  developed  their  normal  length.    Arrest 


Fig  ii 


of  development  of  the  superior  alveolar  process  has  taken  place 
similarly  to  Fig.  206. 

In  Fig.  208  is  shown  quite  a  protrusion  and  forward  move- 
ment of  the  superior  incisors  and  alveolar  process,  the  teeth 
standing  fan-shaped.  The  lower  incisors  are  pressed  inward  and 
crowded  together.  The  space  is  greater  on  the  right  side  than 
on  the  left  showing  the  right  hand  was  used.  Irregularities  of 
the  permanent  teeth,  due  to  thumb-sucking,  are  rare. 


CHAPTER    XXIX. 


THE  DEGENERATE  TEETH. 

The  evolution  of  the  primitive  tooth  from  the  lower  verte- 
brates and  their  dermal  appendages  illustrates  physiologic  p'^o- 
cesses  much  ignored  by  practitioners. 


Fig.  309. 

The  teeth,  as  noted  elsewhere/  were  primitiveU  organs  of 
the  skin  which  developed  over  the  surface  of  the  body.  They 
became  dermal  bones  like  those  which  went  to  furT.i  part  of  the 
skull  elsewhere. 

The  placoid  scales,  which  were  dermal  teeth    n  the  shark, 


Fig.  210. 

helped  out  the  deficiencies  of  the  brain  case.  In  vertebrate 
evolution  the  cartilaginous  scales  were  hardly  suflficient  to  cover 
the  developing  brain,  etc.  The  teeth  of  sharks  depart  from  the 
primitive  method,  since  they  do  not  develop  upon  the  surface, 
but  deep  down  in  the  tissue.     This  method  of  tooth  formation, 

1  Chapter  on  Development  of  the  Teeth. 

362 


THE    DEGENERATE    TEETH. 


363 


converting-  epithelial  cells  without  vascular  supply  into  enamel 
rods,  is  a  degeneration  in  itself.  A  papilla  forms  in  the  dermis 
which  eventually  becomes  the  dentine  of  the  tooth.  The  epi- 
dermis dips  into  the  tissue  below,  enlarges  and  adds  the  enamel. 
The  debris  resulting  therefrom,  observed  in  animals  as  well  as 


Fig.  211. 

man.  is  a  degeneration  or  are  "abortive  rudiments"  of  tooth 
succession,  as  observed  in  sharks,  some  whales  and  reptiles. 
Degeneration  of  structure  in  tooth  formation,  however,  is  more 
worthy  of  attention  than  tooth  evolution.  The  pulp  of  the 
tooth  obtains  its  shape  and  size  to  form  the  dentine.     Calcifica- 


FiR.  212. 

tion  of  dentine  proceeds  from  the  periphery,  while  the  blood  ves- 
sels and  connecting  tissue  recede  until  finally  when  the  root  is 
completely  formed  a  minute  opening  is  left  for  the  passage  of  an 
artery,  vein  and  nerve.  These  not  only  supply  nourishment  to 
the  pulp  of  the  tooth  but  also  to  the  structure  of  the  tooth. 
The  method  of  tooth  formation,  as  compared  with  the  original 


364 


IRREGULARITIES    OF    THE    TEETH. 


placoid  scales,  is  evidently  a  degeneration.  Diseases  which 
ajffect  the  human  body  necessarily  affect  markedly,  structures  so 
poorly  nourished.  Change  in  shape  of  the  alveolar  process  and 
neglect  to  keep  the  alveolar  process  healthy  causes  interstitial 
gingivitis   and   endarteritis  obliterans   (thus  preventing  circula- 


Fig:.  2n. 

tion  and  nourishment  of  the  teeth),  removes  the  resistance,  thus 
furnishing  a  suitable  medium  for  micro-organisms. 

Interglobular  spaces  and  defective  enamel  formation  mark 
tooth  degeneration. 

Tooth  degeneration,  or  decay,  at  one  period  of  stress  (close 
of  the  first  dentition)  or  at  a  period  of  involution  (normal  senil- 
ity) is  a  normal  process,  for  the  carrying  out  of  which  osteo- 


Fig.  214. 


Fig:.  215. 


malaciary  methods  are  provided.  In  polyphyodont  animals  this 
condition  of  tooth  degeneration  is  normally  a  continuous  one, 
since  the  teeth  in  these  do  not  follow  periods  of  stress. 

Man  at  his  present  stage  of  evolution  generally  has  twenty 
teeth  in  his  temporary  and  thirty-two  in  his  permanent  set.  Any 
deviation  in  number  is  the  result  of  embr\^onic  change  occurring 
between  the  sixth  and  fifteenth  week  for  the  temporary  teeth 


THE    DEGENERATE    TEETH. 


365 


and  the  fifteenth  week  and  birth  for  the  permanent.  The  germs 
of  teeth  which  erupt  late  in  Hfe  and  are  (properly)  called  third 
sets,  of  necessity  appear  ere  birth,  and  are  completely  formed 
at  the  beginning  of  the  second  year,  although  they  remain  pro- 
tected in  the  jaw  until  late  in  life. 

More  than  twenty  teeth  in  the  temporary  or  than  thirty-two 
in  the  permanent  is  hence  an  atavistic  abnormality. 

From  a  maxillary  and  dental  standpoint  man  reached  his 
highest  development  when  well-developed  jaws  held  twenty 
temporary  and  thirty-two  permanent  teeth.  Decrease  in  the 
numbers  meant,  from  the  dental  standpoint,  degeneracy,  albeit  it 


Fig.  216. 


might  mark  advance  in  the  man's  evolution  as  a  complete  being. 
Marsh-  points  out  that  in  the  New  Mexican  lower  eocene  occur  a 
few  representatives  of  the  lowest  primates,  such  as  the  lemu- 
rarius  and  limnotherium,  each  the  type  of  a  distinct  family.  The 
lemurarius,  most  nearly  alHed  to  the  lemurs,  is  the  most  gener- 
alized primate  yet  found.  It  had  forty-four  teeth  in  continuous 
series  above  and  below.  The  limnotherium,  while  related  to 
the  lemurs,  had  some  affinities  with  the  American  marmosets. 
A.    H.    Thompson,^    in    discussing    the    "missing    teeth"    of 

2  Vertebrate  Life    ( Proceedings  American  Association  for  Advance- 
ment of  Science,  1877). 
•  Dental  Cosmos,  1894. 


366 


IRREGULARITIES    OF    THE    TEETH. 


man,  remarks  that  these  researches  of  Marsh  suggested  and 
subsequent  studies  aided  the  solution  of  the  problem  of  the 
origin  of  the  extra  teeth  (known  as  supernumeraries)  that  some- 
times occur  in  man.  These,  usually  regarded  as  pure  freaks, 
like  polydactylism,  are,  however,  beautiful  illustrations  of  ata- 
vism, and  demonstrate  that  man  during  his  evolution  from  the 
lowest  primate  has  lost  twelve  teeth.  These  supernumerary 
teeth  assume  two  forms, — either  they  resemble  the  adjoining 
teeth  or  are  cone-shaped.  While  they  rarely  are  exactly  coun- 
terparts, every  tooth  can  be  and  is  duplicated,  as  the  following 
illustrations  show.     Fig.  209  illustrates  fairly  well-formed  dupli- 


Fig,  21 


cate  central  incisors,  the  normal  incisors  being  outside  the  dental 
arch.  They  are  crowded  laterally  by  the  large  roots  of  the 
supernumerary  incisors.  Fig.  210  shows  an  extra  right  lateral 
in  a  temporary  set  in  the  upper  jaw;  Fig-.  211,  an  extra  right 
lateral  in  the  permanent  set.  Fig.  212  illustrates  normally  devel- 
oped supernumerary  cuspids,  which  are  all  grouped  together 
upon  the  right  side,  the  bicuspids  being  also,  duplicated  on  each 
side;  indeed,  all  but  the  molars  are  duplicated.  Fig.  213  shows 
supernumerary  third  molars  easily  demarcated  from  the 
normal  molars.  The  teeth,  which  fail  to  approximate  their  nor- 
mal neighbors,  assume  the  cone  shape  of  the  primitive  tooth. 


THE    DEGENKRATE    TEETH. 


367 


The  fact  that  the  cone-shaped  tooth,  as  a  rule,  is  perfect  in 
construction,  is  found  everywhere  in  the  jaw,  but  especially  in 
the  anterior  and  posterior  part  of  the  mouth,  is  of  much  value 
in  outlining  tooth  and  jaw  evolution,  especially  from  degener- 


Fig.  218. 
Smale  and  Colyer. 

acy  aspects.  The  upper  jaw  being  an  integral  part  of  the  skull 
and  fixed,  is  of  necessity  influenced  by  brain  and  skull  growth, 
hence  degeneracy  is  more  detectable  in  it  than  in  the  lower. 

The  evolution  of  the  jaw  is  towards  shortening  in  both  direc- 
tions.   This  shortening  will  continue  so  long  as  the  jaw  must  be 


Fig.  219. 

adjusted  to  a  varying  environment.  The  jaw  of  man  having 
originally  contained  more  teeth  than  at  present,  lack  of  adjust- 
ment to  environment  produces  from  the  shortening,  degeneracy 
of  the  jaw  and  atavism  of  the  teeth.     While  this  may  coincide 


368 


IRREGULARITIES    OF    THE    TEETH. 


with  general  advances  of  the  individual,  it  indicates  that  he  is 
not  yet  adjusted  to  his  new  environment.  The  shortening  of  the 
upper  jaw  causes  supernumerary  cone-shaped  teeth  to  erupt  in 
mass  at  the  extreme  ends  of  the  jaw,  as  shown  in  the  following 


Fig.  220. 

figures.  Fig.  214  illustrates  a  cone-shaped  tooth  between  the 
two  central  incisors,  forcing  them  out  of  position.  Fig.  215 
shows  three  supernumerary  teeth ;  a  cone-shaped  tooth  between 
the  central,  lateral,  and  cuspids  out  of  position.     The  left  per- 


Fig  221 


manent  lateral  is  at  the  median  line,  another  cone-shaped  tooth 
remains  in  the  vault,  while  the  supernumerary  left  lateral  is  in 
place.  As  many  as  eight  are  at  times  to  be  observed  in  the 
anterior  vault.     Posteriorly  these  teeth  are  most  often  noticed 


THK    DEGKNERATE    TEETH. 


369 


in  connection  with  third  molars,  usually  on  a  line  with  other 
teeth,  posterior  to  the  last  molar.  Fig.  216  shows  two  super- 
numerary cus])i(ls  in  the  anterior  and  two  in  the  posterior  part 
of    the    left    ari-h ;    the    molars    have    been    extracted       Super- 


;yA. 


A 


Fig.  232. 


numerary  teeth  are  not  confined  to  these  localities,  but  may  be 
observed  at  any  point  in  the  dental  arch.  (Figs.  217  and  218.) 
The  primitive  cone-shaped  tooth  is  rarely  observed  in  the  lower 


Fig.  223. 


jaw.    The  mobility  of  the  lower  jaw  prevents  that  maladjustment 
to  environment  present  in  the  upper. 

The  continual  shortening  in  both  directions  of  the  jaw  causes 
the  third  molars  frequently  so  to  wedge  in  between  the  angle 
of  the  jaw  and  the  second  molar  that  eruption,  if  possible,  is 

25 


370 


IRREGULARITIES    OF    THE    TEETH. 


difficult.  The  third  molar  is  often  absent  in  the  Caucasian  races. 
In  forty-six  per  cent  of  six  hundred  and  seventy  patients  it  was 
missing.  Frequently  its  development  is  abortive.  This  tooth 
in  the  struggle  for  existence  seems  destined  to  disappear.    It  is 


Fig.  224. 
American  System  of  Dentistry. 


more  often  absent  from  the  upper  than  the  lower  jaw.  When 
absent  or  badly  developed  the  jaw  is  smaller,  and  frequently 
teeth  irregularities,  nasal  stenosis,  nasal  bone  and  mucous  mem- 
brane hypertrophy,  adenoids,  and  eye  disorders  coexist.     Fig. 


Fig.  225. 

219  shows  absence  of  the  left  third  molar,  with  irregularities 
of  that  side  of  the  arch.  In  Fig.  220  both  third  molars  are  seen 
to  be  missing,  coincident  with  irregularities  on  both  sides  of 
the  arch.  Anteriorly  the  lateral  incisors  are  most  often  wanting; 
fourteen  per  cent  of  the  laterals  were  wanting  in  six  hundred 


THE    DEGENERATE    TEETH. 


371 


and  seventy  patients.  In  the  progress  of  evolution  man  has  lost 
one  lateral  upon  each  side  of  the  mouth,  and  the  second  lateral 
seems  also  destined  to  disappear.  In  Fig.  221  the  left  lateral 
incisor  has  disappeared,  and  in  Fig.  222  both  lateral  incisors 
are  absent.  Not  infrequently  does  it  occur  that  centrals,  cuspids, 
bicuspids,  and  even  molars  are  absent ;  even  their  germs  are  not 
detectable.  Fig.  223  illustrates  a  cast  showing  three  supernumer- 
aries in  the  anterior  part  of  the  mouth  and  but  two  molars.    The 


Plfir.  226. 

American  System  of  Dentistry. 

absence  of  teeth  indicates  lack  of  development  of  germs,  due 
either  to  heredity  or  defective  maternal  nutrition  at  the  time  of 
conception   or  during  early   pregnancy. 

Crescent-shaped,  bitubercular,  tritubercular,  as  well  as  all 
deformed  teeth  tend  to  the  cone  shape.  The  malformation  of 
these  teeth  results  from  precongenital  trophic  change  in  dentine 
development.     It  consists  in  dwarfing  and  notching  the  cutting 


FiK.  22: 


Fig.  229. 


Fig.  228. 

and  grinding  edges  of  the  second  set  of  teeth,  a  familiar  example 
of  which  is  seen  in  the  so-called  Hutchinson  teeth,  usually 
referred  to  a  syphilitic  etiology.  Hutchinson's  position  has, 
however,  been  more  strongly  stated  than  his  words  justify,  since 
he  admits  that  in  at  least  one-tenth  the  cases  luetic  etiology  could 
be  excluded.'* 

Lues  only  plays  the  part  of  a  diathetic  state  profoundly  affect- 
ing the  maternal  constitution  at  the  time  of  dentine  development. 

*  American  System  of  Dentistry. 


S72  IRREGULARITIES    OF    THE    TEETrt. 

While  these  teeth  may  be  due  to  secondary  result  of  lues,  they 
do  not  demonstrate  luetic  heredity. 

In  Fig.  224  are  seen  the  teeth  of  an  individual  affected  with 
very  marked  constitutional  disease.  The  degree  of  pitting  will 
depend,  as  a  rule,  upon  the  severity  of  the  constitutional  dis- 
order. In  the  case  just  cited,  however,  although  nutrition  was 
but  slightly  disordered,  each  tooth  shows  a  tendency  to  conate. 
Not  infrequently  are  cavities  extended  completely  through  the 
tooth.  The  cusps  of  the  (permanent)  first  molars  calcifying  at 
the  first  year  are  usually  attacked  also  and  arrested  in  devel- 
opment, producing  the  cone  shape.  These  data,  together  with 
dates  of  eruption  of  the  temporary  and  permanent  teeth,  furnish 
an  absolute   basis   for   calculation   as   to   excessive  or   arrested 


Fig.  231. 

development  of  tissue.  Fig.  225  shows  a  very  degenerate  jaw 
with  cone-shaped  malformed  bicuspids.  The  right  lateral  is 
missing,  the  cuspids  are  erupting  in  the  vault,  and  the  dental 
arch  is  assuming  a  V-shape.  The  jaw  as  a  whole  shows  marked 
arrest  in  development.  Fig.  226  shows  "Hutchinson"  teeth. 
Were  the  first  molars  visible  they  would  present  marked  con- 
traction of  the  outer  surface  with  a  malformed  center. 

Figs.  227,  228,  229,  230,  and  the  molars  in  Fig.  223  exhibit 
malformations,  assume  the  cone  shape,  and  the  center  frequetuly 
associated  with  this  type  of  teeth.  The  coincidence  in  form 
between  "Hutchinson"  and  malformed  teeth  and  those  of  the 
chameleon  demonstrates  that  tropho-neurotic  change  produces 
atavistic  teeth.    Fig.  231  illustrates  the  tendency  of  human  bicus- 


THE    DEGENERATE    TEETH.  373 

pids  (when  there  is  no  antagonism)  to  rotate  one-fourth  round, 
thus  again  demonstrating  the  atavistic  tendency  towards  the 
teeth  of  the  chameleon.  Fig.  232  exhibits  extreme  atavism; 
all  teeth  anterior  to  the  molars  are  cone-shaped.  The  third 
molars  are  missing  and  would  probably  never  erupt.  In  Fig.  233 
appears  more  marked  atavism.  The  upper  and  lower  anterior 
are  both  cone-shaped  and  the  superior  first  bicuspid  exhibits 
a  tendency  thereto.    The  right  superior  second  bicuspid,  second 


Fig    Zii 
Smale  and  Colyer. 


and  third  molars,  the  right  inferior  first  and.  second  bicuspids, 
second  and  third  molars  are  missing.  The  same  condition  prob- 
ably exists  on  the  left  side.  The  space  in  the  upper  jaw  is  due 
to  the  insufficient  width  of  the  teeth.  Alternation  of  teeth  in 
the  upper  and  lower  jaws  is  a  reptilian  feature.  Fig.  223  fur- 
nishes an  excellent  ilkistration  of  the  principles  hereinbefore 
advanced. 

In  degenerate  jaws  the  influence  of  the  factors  of  the  differ- 


Fig-    233. 
Smale  and  Colyer. 

entiation  theory  are  also  demonstrated.  Every  tooth  in  the  jaw 
at  one  point  or  another  may  display  rudimentary  cusps.  On 
the  incisors  they  are  always  to  be  found  on  the  lingual  surface. 

Fig.  234  illustrates  the  centrals  with  two  rudimentary  cusps, 
the  laterals  with  one  and  the  cuspids  with  one  also.  Fig.  235 
represents  cusps  upon  the  lingual  surfaces  of  the  molars.  The 
cuspids  are  not  unlike  the  lower  bicuspids  with  a  rudimentary 
lingual  cusp. 

Thompson  remarks  that  there  is  a  gradation  from  central 


374  IRREGULARITIES    OF    THE    TEETH. 

incisors  towards  the  bicuspids  in  evolution.  This  grading  of 
form  is  not  observed  in  the  passage  from  the  cuspid  to  the 
bicuspid  in  man.  But  it  should  be  remembered  that  the  cuspid 
often  presents  a  cingulum  on  the  lingual  face  that  inclines  it 
towards  the  bicuspid  forms  in  lower  mammals,  like  the  mole, 
and  that  the  first  premolar  or  bicuspid  is  then  more  caniniform, 
the  inner  tubercle  being  much  reduced.  This  inner  tubercle  is 
very  variable  and  erratic  as  to  its  position.  It  appears  as  far 
front  as  the  centrals  and  is  often  present  on  the  lingual  face  of 
the  laterals  of  man.  The  lingual  tubercle  is  very  constant  on 
the  first  bicuspid  of  man  and  is  well  developed  as  the  buccal. 
But  in  some  lower  forms,  as  in  the  lemurs,  it  is  quite  deficient. 


Fig.  2.34. 

It  attains  the  highest  development  only  in  the  anthropoids  and 
man.  Considering  these  stages  of  development,  the  grading 
from  the  cuspid  to  the  bicuspid  forms  was  more  gradual  in  the 
earlier  species  than  in  the  later,  where  the  individual  teeth  have 
taken  on  special  development.^ 

The  skull  of  a  degenerate  girl,  who  died  from  tuberculosis 
at  thirteen  years,  has,  among  other  stigmata,  a  cusp  on  the 
external  surface  of  a  right  inferior  cuspid.  This  is  a  decidedly 
strong  point  in  favor  of  the  differentiation  theory.  Another 
strong  point  in  favor  of  this  theory  occurs  in  Fig.  236,  where 

•>  Dental  Cosmos,  May,  1894. 


THE    DEGENERATE    TEETH. 


375 


every  tooth  is  present  and  a  most  remarkable  display  of  cusps 
occurs.  The  cusps  upon  the  cutting  and  grinding  edges  are  not 
obliterated.  Commencing  with  the  left  superior  central  incisor 
three  cusps  are  present  with  a  rudimentary  palatine  cusp.  The 
laterals  also  show  three  cusps,  while  the  cuspid  has  two  very 
distinct.  The  first  and  second  bicuspids  have  tubercular  cusps, 
they  being  in  line.  The  buccal  cusps  upon  the  molars  two  to 
three  and  are  still  in  position.  The  palatine  cusps  are  worn 
away.    The  same  is  the  case  upon  the  opposite  side  except  that 


Fig.  235. 


the  cuspid  has  cusps  that  have  fused  together,  leaving  a  small 
projection  upon  the  mesial  side  and  a  rudimentary  palatine  cusp. 
The  cusp  upon  the  third  molar  is  lost.  In  another  case  (Fig.  218) 
the  primitive  cone  teeth  are  seen  trying  to  shape  themselves 
into  incisors.  The  lateral  incisors,  cuspids,  and  bicuspids  are  still 
cone-shaped.  The  first  permanent  molar  is  fairly  formed,  while 
the  second  molars  are  still  in  a  primitive  condition.  The  points 
made  by  Osborn  are  fully  demonstrated  in  the  two  last  illustra- 
tions,— namely,  the  triangular-shaped  crowns  and  the  levelling  of 
cusps. 


376 


IRREGULARITIES    OF    THE    TEETH. 


There  is  abundant  evidence  to  show  that  degenerate  teeth 
unite  in  twos,  threes,  fours,  and  fives,  as  indicated  in  the  con- 
crescent  theory.  These  single  cone-shaped  teeth  grow  together 
and  form  bicuspids  and  molars.  The  germs  of  any  two  normal 
teeth  may  intermingle  and  unite ;  not  only  are  the  crowns  found 
united  with  separate  roots,  but  crowns  and  roots  are  united 
throughout. 

Figs.  237  and  238  show  two  superior  central  and  lateral 
incisors  joined  together  throughout  the  entire  length  of  crown 
and  root ;  Fig.  239,  two  lower  incisors  are  united  throughout ; 


Fig.  2.^(;. 

Smale  and  Colyer. 

Fig.  240  shows  a  cuspid  with  two  roots ;  George  T.  Carpenter, 
of  Chicago,  has  a  right  superior  second  bicuspid  with  three 
well-formed  roots ;  Fig.  241  illustrates  two  bicuspids  united  at 
the  crowns ;  Fig.  242  shows  two  molars  perfectly  united ;  Fig. 
243  illustrates  central  and  lateral  incisors  of  the  permanent  set 
perfectly  united;  Fig.  244  shows  two  molars  united;  Fig.  245 
a  molar  and  supernumerary  united,  the  supernumerary  taking 
the  cone  shape  with  deformed  center.  Fig.  246  shows  three  mal- 
formed teeth,  each  conated  and  completely  united. 

It  is  not  uncommon  to  find  three  molars  united  together,  as 
for  instance  the  second,  third,  and  supernumerary  molar.    C.  V. 


THE    DEGENERATE    TEETH. 


s?*; 


Rosser,  Atlanta,  Georgia,  has  two  small  molars  and  a  super- 
numerary cuspid  perfectly  united  from  crown  to  root,  and  these 
three  further  united  to  the  roots  of  a  well-formed  molar.  Thus 
we  see  the  concrescence  theory  is  fully  established. 

A  condition  of  molar  tooth  occasionally  observed  in  America, 
but  more  often  in  England,  Scotland  and  Ireland,  is  that  where 
the  crown  is  flattened  from  side  to  side  (Fig.  247)  and  the  roots 
nearly  or  quite  on  a  line.  Instead  of  being  normal  like  Fig.  248, 
they  stand  like  Fig.  249.  These  teeth  are  generally  observed 
in  jaws  of  arrested  deveIo])nient.  The  third  or  last  molar,  be  it 
second  or  first,  is  usually  affected. 

Dr.  S.  H.  Guilford  was  the  first  to  call  attention  to  this  par- 
ticular anomaly  in  the  American  System  of  Dentistry,  page  416, 
under  the  heading,  "Com])ressed  or  Flattened  Crowns."  He 
savs,  "among;  the  anomalies  of  tooth  structure  or  formation  this 


Fig.  237. 


Fig.  2.98.  Fig.  239. 

Smale  and  Colyer. 


Fig.  240. 


one  is  quite  rare.  The  crowns  of  this  character  are  flattened 
in  an  antero-posterior  direction,  so  that  their  diameter  trans- 
versely of  the  jaw  is  by  far  the  greater  one.  The  fissures  or 
culci,  instead  of  presenting  the  usual  form,  are  distorted  and 
sigmoid  in  shape,  corresponding  with  the  long  diameter,  while 
the  cusps  resolve  themselves  into  narrow  ridges  somewhat  after 
the  manner  of  the  molars  of  the  Ruminantia.  The  third  molars 
of  the  superior  arch  are  the  ones  usually  affected,  although  the 
writer  has  seen  one  case  in  which  the  superior  first  molar  pre- 
sented the  same  condition." 

William  Booth  Pearsoll,*'  of  Dublin,  Ireland,  called  the  atten- 
tion to  this  abnormality  at  the  1888  meeting  of  the  Royal  College 
of  Surgeons,  Ireland.  The  question  arose  in  connection  with 
extraction,  since  there  was  dif^culty  in  seizing  the  tooth  with 
the  forceps  because  of  the  shape  of  the  crown  and  roots.    These 

6  Dental  Review,  Jan.  15,  1899, 


378  IRREGULARITIES    OF    THE    TEETH. 

teeth  are  usually  found  in  degenerate  jaws.  Like  most  dental 
abnormalities  observed  in  degenerate  jaws  these  teeth  are  ata- 
vistic, reverting  in  crown  and  roots  to  the  original  "tricono- 
dont"  type  with  cusps  and  roots  in  line.  The  roots  are  some- 
times separated,  containing  two  or  three,  or  there  may  be  only 
one  flattened  upon  the  sides. 

In  degeneracy  are  peculiarly  well  illustrated  the  operation 
of  the  law  of  economy  of  growth  producing  arrested  and  exces- 
sive development  as  seen  in  edentulousness  and  excessive  denti- 
tion. 

As  Darwin  points  out,  hairless  dogs  have  imperfect  teeth. 
Here  the  dermic  defects  affected  the  animal  as  a  whole ;  other 
organs  profiting  by  the  deficiencies  of  the  hair  and  teeth.  In 
most  cases  of  hairy  men.  there  is,  as  Magitot  remarks,  defective 
or  irregular  dentition.     Here  the  struggle  for  existence,  (which 


Fig.  241.  Fig.  -^42. 

Smale  and  Colyer. 

has  been  between  the  teeth,  which  are  derived,  as  elsewhere 
shown,  originally  from  the  skin,)  is  now  between  the  teeth  and 
the  hair.  In  the  case  reported  by  Thurman,  a  man  fifty-eight 
years  of  age,  who  was  almost  devoid  of  hair  all  his  life,  possessed 
only  four  teeth.  His  skin  was  very  delicate.  There  was  absence 
of  sensible  perspiration  and  tears.  The  skin  was  peculiar  in 
thinness,  softness  and  absence  of  pigmentation.  The  hair  on  the 
crown  of  the  head  and  back  was  very  fine,  short  and  soft  and 
in  quantity  about  that  of  a  three-months  infant.  A  similar 
condition  existed  in  his  cousin-german.  In  a  case  reported  by 
Williams,  a  fifteen-year-old  girl  had  scarcely  any  hair  on  the 
eyebrows  or  head  and  was  destitute  of  eyelashes.  She  was 
endentulous  and  had  never  sensibly  perspired.  "Jo-Jo,"  the 
famous  "Dog-man,"  had  very  defective  teeth.  Borelius  found 
atrophy  of  all  the  dental  follicles  in  a  woman  of  sixty  who  had 
never  possessed  any  teeth.     Fanton-Touvet  saw  a  boy  of  nine 


THE    DF.GKNF.RATE    TEETH.  379 

who  had  never  had  teeth.  Fox  reports  a  woman  who  had  but 
four  in  both  jaws.  Tomes  cites  several  similar  instances.  Hutch- 
inson reports  a  child  who  was  perfectly  endentulous  as  to  tem- 
porary teeth  but  whose  permanent  teeth  duly  and  fully  erupted. 
Guilford  describes  a  man  of  forty-eight  congenitally  and  per- 
manently edentulous,  who  had  no  sense  of  smell  and  almost 
without  taste.  The  surface  of  his  body  was  covered  with  fine 
hairs.  He  had  never  had  visible  perspiration.  Otto  observed 
two  edentulous  brothers.''' 

Excessive  dentition  shows  itself  in  many  varieties.  Those 
which  constitute  return  to  the  polyphyodontia  of  the  lower  verte- 
brates. O.  Hildebrand.  of  Gottingen.^  Germany,  in  1889 
reported  the  case  of  a  child  of  twelve  which,  after  various  oper- 


Fi?.  243. 


ations,  had  been  relieved  of  about  two  hundred  teeth  of  various 
sizes.  Tw^o  years  later  (July,  1891)  the  patient  came  under  obser- 
vation^  at  the  Gottingen  Surgical  Clinic.  Both  sides  of  the  lower 
jaw  were  much  thickened,  as  also  was  the  right  upper  jaw. 
There  were  found  seventeen  teeth,  part  of  them  normally  devel- 
oped, others  in  an  undeveloped  condition.  Their  position  was 
deviated  and  irregular.  From  the  upper  and  lower  jaw  there 
were  again  some  masses  of  teeth  removed  (which  had  the  same 
conformation  as  those  described  in  1889).  which  represented 
about  150  teeth.  There  were  also  found  two  round,  glassy 
bodies  about  the  size  of  two  peas,  which  upon  microscopical 

7  Gould's  Anomalies. 

8  Medical  and  Surgical  Reporter,  July  15,  1890. 
^  Centralblatt  f.  Chirurgie,  1892. 


380 


IRREGULARITIES    OF    THE    TEETH. 


investigation  showed  tooth  structure.  This  is  a  return  to  poly- 
phyodontia  from  arrest  of  development  very  early  in  foetal  life. 
Beside  the  supernumerary  teeth  elsewhere  described,  arrests 
of  development  producing  excessive  dentition  may  evince  them- 
selves in  double  rows  and  in  anomalous  position.  In  the  Paris 
Dental  School  Museum  are  several  milk  teeth  both  of  the 
superior  and  inferior  maxilla  fused  together.  Bloch  cites  a  case 
where  there  were  two  rows  of  teeth  in  the  superior  maxilla. 
Hellwig  has  observed  three  rows  of  teeth.  The  Ephemerides 
contain  an  account  of  a  similar  anomaly.  Teeth  have  been 
found,  as  Gould  points  out,  in  the  nose,  orbit,  palate  and  excep- 
tionally, as  in  a  case  reported  by  Carver,  they  may  grow  from 
the  lower  eyelid.  In  Carver's  case  the  number  of  deciduous 
teeth  was  perfect.  Although  the  supernumerary  tooth  was 
canine  it  had  a  somewhat  bulbous  fang.    Arrest  of  development 


Fig.  2U. 


Fir.  •.'45. 


Fig.  846. 


proceeding  from  checked  development  at  the  senile  period  of 
foetal  life  may  evince  itself  in  senility  of  the  alveolar  process,  as 
in  a  case  reported  by  Bronzet,  where  a  child  of  twelve  had  but 
half  its  teeth,  the  alveolar  process  having  receded  as  in  age. 

Such  arrest  of  development  may  also  produce  polyphyodont 
conditions  in  the  human  being.  Catching^*^  reports  the  case  of 
a  girl  v,'ho  had  all  her  teeth  at  six  months  and  shed  these  at 
nine.  At  fifteen  months  she  had  a  full  set  once  more.  In  six 
weeks  thereafter  these  were  shed.  At  thirty  months  she  had  a 
full  set  again,  which  remained  until  her  fourth  year,  when  came 
another  set.  These  remained  until  another  set  began  to  erupt 
at  eleven  and  became  the  permanent  set  complete  at  fifteen. 

The  homology  of  the  dental  tissues  with  the  tissues  of  the 
derm,  already  .pointed  out,  and  the  special  identity  of  the  enamel 
with  the  extra  vascular  appendages,  render  it  certain,  as  A.  H. 

^°  Boston  Medical  and  Surgical  Journal,  July  loth,  1887. 


THE   DEGENERATE   TEETH.  381 

Thompson,^^  of  Topeka,  Kansas,  points  out,  tlic)  are  i^^ovcrned 
by  the  same  laws,  subject  to  the  same  inllucnces,  and  possess 
the  same  phenomena  of  character  as  the  allied  tissues.  Com- 
munity of  origin  and  similarity  of  structure  and  nature  neces- 
sarily establish  identity  of  the  manner  of  life,  of  the  methods 
of  maintaining  life  with  its  varied  phenomena  of  similarity  of 


'-  Fig.  247. 

service  rendered  to  the  economy  and  of  the  process  of  dissolution 
and  expulsion  from  the  system.  The  relationship  and  homology 
of  the  teeth  with  the  derm  and  its  varied  appendicular  produc- 
tions are  established  by  demonstration.  These  can  well  be  and 
yet  preserA^e  the  unity  of  character,  which  they  do  not  fail  to  do. 
Teeth,  spines,  scales,  dermal  plates,  feathers,  nails,  hair,  bristles, 


Fig.  a48.  Fig.  5249. 

Dental  Review. 

horn,  hoof,  etc.,  varied  in  form  and  apparent  purpose  as  tissues 
can  well  attain,  are  yet  closely  related  in  structure  and  function, 
with  variations,  of  course,  within  certain  limits. 

The  enamel  consists  of  calcified  epithelial  cells  elaborated 
for  the  endurance  of  an  appointed  work  and  service  in  the  econ- 
omy.     Enamel,   like   epithelium    and   all   corneous   structures, 

11  Dental  Cosmos,  Vol.  ig,  page  22,"]. 


382  "'irregularities  of  the  teeth. 

yields,  as  A.  H.  Thompson  remarks,  keratin.  In  such  unstable 
structures  in  evolution  as  the  teeth,  arrest  of  development  would 
tend  to  produce  for  this  reason,  in  place  of  enamel,  horny 
structures.  Indeed,  this  occurs  physiologically  in  certain  verte- 
brates. In  that  oviparous  mammal,  the  duck-bill  (ornithorhyn- 
cus), true  teeth  appear  in  the  embryonic  state  to  give  way  later 
by  what  Thompson  calls  suppressive  economy  or  the  degener- 
ative results  of  the  struggle  for  existence  between  the  organs, 
to  horny  structures.  The  same  condition  must  have  appeared 
when  the  toothed  birds  began  to  lose  their  teeth  in  the  tertiary. 
Arrests  of  development  in  man  may,  therefore,  produce  what  is 
seeriiingly  a  reversion  to  this  condition  of  the  duck-bill.  As 
has  already  been  pointed  out  in  the  chapter  on  Developmental 
Neuroses  of  the  Face,  neurotic  cases  occur  in  which,  from  arrests 
of  development,  there  is  very  little  enamel  upon  the  teeth. 


CHAPTER   XXX. 


SURGICAL   DIAGNOSES. 

In  all  branches  of  medicine  and  surgery,  the  patient  rather 
than  the  symptoms  rccjuires  treatment.  In  dealing  with  treat- 
ment, the  origin  as  well  as  the  symptom  requires  examination. 
To  remove  the  symptom  without  ascertaining  its  cause  is  to  fail 
utterly  in  the  main  object,  the  removal  or  amehoration  of  the 
disorder.  More  disrepute  has  fallen  upon  dentists  from  this 
cause  than  upon  general  surgeons,  since  the  latter  make  an 
attempt  to  deal  with  the  patient's  disorder  from  the  side  of  its 
causation.  It  is  equally  important,  therefore,  for  the  dentist  to 
look  beyond  the  mouth  for  the  origin  of  the  disorder  therein 
found. 

Frequently  when  a  case  of  irregularity  is  presented,  the  gen- 
eral contour  and  profile  of  the  face  will  show  whether  the  case 
be  one  of  constitutional  type,  the  external  proportions  being 
affected  by  a  decided  V-shaped  arch,  excessively  developed  alve- 
oli or  underhung  jaw.  The  first  thing  a  dentist  should  learn 
are  what  constitutes  a  normal  face  and  jaw  in  a  given  individual 
and  how  to  observe  carefully.  In  determining  correctness  or 
incorrectness  of  the  outline  of  the  mouth  and  jaw  he  instinctively 
takes  it  in  as  a  whole  on  the  same  principle  that  when  looking 
at  a  portrait  he  decides  it  a  likeness  but  reserves  judgment  on 
details. 

Observe  each  jaw.  See  if  it  have  a  normal  outline  or  belongs 
to  the  V  or  saddle-shaped  variety.  Notice  the  vault  and  alveolar 
processes.  Examine  the  occlusion,  letting  the  patient  open  and 
close  his  mouth  slowly.  No  detail  must  go  unnoticed.  The 
beginner  should  familiarize  himself  with  the  individuality  of  teeth 
as  to  class,  outline  and  occlusion. 

When  there  is  asymmetry  of  the  upper  and  lower  jaws,  occlu- 
sion from  the  cuspid  back  is  usually  wrong.  In  such  cases  it 
generally  strikes  in  front  of  the  lower  cuspid  instead  of  between 
it  and  the  bicuspid,  disarranging  the  articulation  of  every  tooth 

back. 

383 


384  IRREGULARITIES    OF    THE    TEETH. 

The  difficulty  in  local  irregularities  is,  as  a  rule,  readily 
detected.  It  is  either  found  in  the  alveolar  arch  or  the  malposi- 
tion of  the  individual  teeth. 

The  first  inquiry  should  be  into  the  family  history.  I  cannot 
agree  with  Kingsley  "that  it  is  useless  to  try  to  correct  an  irreg- 
ularity peculiar  to  a  family  type,  nature  reverting  to  her  original 
design,  notwithstanding  long-continued  efforts."  I  have  shown 
elsewhere  (especially  in  America),  owing  to  changes  in  cli- 
mate, food  and  marriage  with  different  nationalities,  the  shape 
of  heads,  faces,  and  jaws  will  change  from  one  extreme  to  the 
other  in  four  generations.  Again  evolution  in  face  and  jaw 
forms  goes  on  so  rapidly  that  the  tissues  are  too  unstable  to 
present  fixed  forms  of  jaws.  In  a  general  way,  it  can  be  said 
there  is  no  such  thing  as  family  type  in  relation  to  jaws  and 
teeth.  While  it  is  possible  (as  I  have  elsewhere  shown)  for  the 
child  to  inherit  a  family  type  of  face,  still  irregular  teeth  cannot 
be  said  to  be  an  inheritance,  since  order  and  manner  of  their 
eruption  and  position  assumed  are  purely  mechanical.  There  are 
never  two  irregularities  alike.  It  is  oftentimes  well  to  wait  until 
the  patient  is  of  an  age  when  the  permanent  type  of  jaw  can 
be  determined.  Tooth  regulation  before  that  period  is  in  many 
cases  a  very  unsatisfactory  operation.  Every  case  can  be  modi- 
fied and  thus  be  made  less  unsightly.  Knowledge  of  evolution 
and  its  reverse  phase  degeneration,  as  well  as  heredity  anci 
atavism,  are  necessary  factors  in  the  skill  of  the  operator.  The 
first  examination  should  be  supplemented  by  a  study  from  the 
model. 

In  prognosis,  extent  of  deformity  must  be  taken  into  consid- 
eration. Many  cases  will  be  corrected  without  interference. 
Cuspids  and  bicuspids  not  infrequently  erupt  out  of  position,  but 
gradually  find  their  proper  places. 

During  the  second  dentition  deformities  are  common,  while 
some  deciduous  teeth  remain  in  position.  Difference  in  size  of 
the  two  sets  of  teeth  and  consequent  mal-occlusion  alarm  those 
not  familiar  with  these  deformities;  here  time  will  harmonize. 

Caution  should  be  exercised  in  statements  as  to  the  ease, 
difficulty  of  correction  or  the  time  required.  Many  cases  which 
seemingly  present  no  difficulty  often  give  much  trouble,  since 
the  resistance  cannot  be  determined.     Time  spent  in  careful 


SURGICAL    DIAGNOSKS.  385 

examination  of  the  case  is  well  spent.  Haste  here,  as  elsewhere, 
makes  waste.  Every  particular  in  the  deformity  must  be  studied. 
The  dentist  must  forecast  in  his  mind  appliances  to  be  used,  the 
different  steps  to  be  taken  and  time  required  before  prognosis 
can  be  given  with  approximate  exactness. 

Approximately  the  best  time  for  interference  is  from  the 
twelfth  to  the  fourteenth  year.  At  this  time — the  transitional 
period  between  childhood  and  puberty — all  of  the  teeth  are 
erupted,  general  nutrition  is  most  active,  the  osseous  system 
is  in  constructive  stage  and  formative  processes  are  in  operation. 
Where  maxillary  arrest  of  development  is  present,  arrest  or 
retardation  in  completion  of  the  root  may  result.  The  roots 
not  fully  developed  are  more  or  less  loosely  confined  within 
the  alveoli.  The  apical  foramina  are  large,  which  lessens  liabil- 
ity of  blood  supply  impairment  and  consequent  destruction  of 
the  pulp. 

Since  the  conditions  existing  between  the  twelfth  and  six- 
teenth year  are  coincident  with  the  completion  of  tooth  eruption 
the  converse  holds  true.  Hence  where  the  teeth  are  fully 
erupted,  the  dentist  may  operate,  irrespective  of  the  age  of  the 
patient. 

The  chances  for  perfectly  satisfactory  results  in  regulating 
decrease  yearly  after  puberty  and  after  twenty-six  are  very 
meagre.  At  this  time  the  entire  osseous  system  is  fully  devel- 
oped. An  unusual  amount  of  force  is  required  to  set  up  inflam- 
mation and  absorption.  It  is  possible  to  regulate  deformities 
as  late  as  the  thirtieth  year.  The  resulting  pain  is,  however, 
so  severe  and  the  mechanical  force  necessary  to  produce  absorp- 
tion of  the  obstructive  portions  of  the  alveoli  so  great  that  the 
results  hardly  justify  the  procedure.  When  regulated  so  late 
in  life,  retentive  and  corrective  plates  must  be  worn  for  years, 
until  ossific  material  has  formed  to  retain  the  teeth  in  place. 

Sometimes  in  late  correction,  especially  when  extensive  oper- 
ations are  performed  and  absorption  of  the  alveolar  process  is 
not  followed  by  compensatory  ossific  deposit,  mechanical  inter- 
ference produces  chronic  inflammation  of  the  peridental  mem- 
brane (a  veritable  interstitial  gingivitis),  and  later  excessive  ab- 
sorption of  the  gums  and  alveolar  process.  This  condition  is 
noticeable  in  the  mouths  of  patients  who  have  had  extended 

26 


386  IRREGULARITIES    OF    THE    TEETH. 

and  it  may  be  said  ill-advised  operations.  If  the  teeth  must  be 
regulated  at  this  period  of  life,  the  operation  should  be  done 
with  great  care.  The  patient  should  be  impressed  with  a  doubt- 
ful prognosis.  The  alveolar  process  is  a  transitory  structure. 
It  is  present  simply  to  hold  the  teeth  in  place.  The  alveolar 
process  is  removed  when  the  teeth  are  extracted  or  from  irri- 
tation, auto-intoxication  or  senile  absorption.  Hence  the  older 
the  patient,  the  less  the  chances  are  for  a  restoration.  When  the 
patient  insists  upon  an  attempt  at  regulation  and  is  willing  to 
assume  responsibility  of  failure,  dentists  may,  perhaps,  be  justi- 
fied in  operating  in  any  case  of  reasonable  age. 

Physiologic  process  of  regulating  teeth  differs  from  repair  in 
fractures.  Repair,  under  favorable  conditions,  is  possible  even 
in  advanced  age.  In  the  osseous  system  two  parts  of  homo- 
geneous structure  are  united.  This  is  not  the  case  in  correcting 
an  irregularity.  Here  the  tooth  root,  a  dense  structure,  is 
enclosed  in  the  spongy  structure  of  the  alveolus.  Alveolar  nutri- 
tion is  very  active  during  the  first  and  second  dentition  until 
the  roots  are  perfectly  formed  and  to  the  twentieth  year.  After 
that,  blood  supply  being  less,  waste  and  repair  do  not  go 
on  so  rapidly  when  the  alveolus  is  injured.  Lowered  nutrition 
is  sometimes  shown  in  the  separation  of  teeth  and  recession 
of  gums,  in  rapid  wedging  as  well  as  in  interstitial  gingivitis.  The 
fact  that  the  attachment  of  a  tooth  to  the  alveolus  late  in  life 
cannot  be  compared  to  the  union  of  a  fractured  bone  is  evident 
in  the  aptitude  of  teeth,  where  regulated,  to  return  to  their 
original  place  unless  kept  in  position  for  some  time  by  an  appli- 
ance aided  by  proper  occlusion.  The  new  tissue  is  not  as  strong 
as  the  original  tissue,  while  the  bones  and  cicatricial  tissue  are 
practically  of  the  same  strength. 

The  general  health  and  constitutional  peculiarities  of  the 
patients  require  attention.  As  the  majority  of  cases  for  regula- 
tion are  found  in  youth,  the  state  of  general  health  is  of  no  slight 
importance.  The  most  favorable  period  for  operation  is,  unfor- 
tunately, one  of  the  most  critical  in  the  life  of  the  patient. 

From  the  age  of  twelve,  the  beginning  of  one  of  the  most 
important  periods  of  stress,  the  rapidly-growing  boy  or  girl  is 
subjected  to  many  physical  changes,  entaihng  profound  disturb- 
ances  of  the  trophic  nervous  system.     Prolonged  and  injudi- 


SURGICAL    DIAGNOSES.  387 

cious  worry,  over-study,  over-exertion,  impure  air,  improper 
food,  sexual  irritation,  auto-intoxication,  as  well  as  other  dis- 
turbing factors  tend  to  become  prominent  in  the  life  of  the 
patient. 

Sexual  disturbance  is  of  especial  importance  on  account  of 
the  periods  of  stress.  When  to  physiologic  perturbations  of  this 
important  period  of  evolution  are  added  influences  of  environ- 
ment, perversions  of  nutrition,  like  rachitis  and  allied  states, 
consequent  upon  congenital  weakness,  improper  dietetics,  hered- 
itary syphilis  or  the  exanthemata,  the  importance  of  taking  into 
account  the  influence  of  the  general  health  upon  operative  pro- 
cedures is  self-evident.  Operation  on  young  persons  in  delicate 
health  should  be  deferred  until  the  constitution  has  improved. 
Dentists  must  recognize  these  general  conditions,  so  that  they 
may  be  properly  treated.  Many  patients  requiring  correction  are 
children  with  unstable  nervous  systems,  whose  physical  devel- 
opment departs  from  the  normal.  The  mucous  membranes  are 
badly  developed,  digestion  and  assimilation  are  faulty.  The 
glandular  system  is  weak.  The  excreta  are  not  properly  elim- 
inated. From  an  undeveloped  nervous  system,  strain  at  this 
period  is  often  attended  with  disastrous  results.  Not  infre- 
quently in  such  patients  later  in  life,  it  is  found  that  the  alveolar 
process  has  not  been  restored.  Interstitial  gingivitis  sets  in 
early,  the  teeth  loosen,  separate  or  crowd  together,  elongate  and 
are  finally  lost. 

Patients  that  present  themselves  are,  unfortunately,  mostly 
neuropaths  and  degenerates.  This  increases  the  danger  from 
careless  procedures.  Here  assimilation  of  the  patient  must  be 
normal.  The  patient  should  be  given  enough  unstimulating  nutri- 
tious food  suited  to  his  particular  case.  It  is  often  difficult  to 
do  this,  since  the  appHance  hinders  mastication.  The  patient 
should  have  abundance  of  sleep  in  a  well-ventilated  room.  He 
should  be  in  the  open  air  as  much  as  possible.  The  mind  should 
be  placid  and  agreeably  occupied  so  as  to  aid  him  to  forget  the 
irritation  during  the  process.  Absence  of  pain  from  lack  of 
physiologic  response  is  as  great  a  tax  on  the  nervous  system  as 
the  pain  itself.  Dentists  should,  therefore,  not  be  satisfied  with 
the  absence  of  complaint  by  the  patient,  who  should,  if  reticent, 


388  IRREGULARITIES    OF    THE    TEETH. 

be  encouraged  to  give  expression  to  his  feelings.  This  aids  in 
deciding  the  time  required  for  each  step. 

To  carry  out  the  programme  it  may  be  necessary  to  take 
the  patient  out  of  school  or  to  diminish  his  tasks.  Schools  are 
generally  badly  ventilated.  Exercise  during  school  hours  is 
almost  impossible.  These  patients  cannot  be  under  routine  dis- 
cipline of  the  school  room  without  detriment  to  health  and 
spirits.  School-life  is  a  heavy  tax  during  development.  The 
strain  of  correcting  an  irregularity  should  not  be  added  to  the 
other  cares  of  puberty  and  adolescence.  Children  during 
puberty  and  adolescence  are  morbidly  conscientious,  ambitious 
and  reserved.  They  suffer  much  and  say  little.  This  is  partic- 
ularly true  of  girls,  who  do  not  find  the  relief  boys  do  in  outdoor 
play.  The  sights  and  sounds  of  field  or  wood  or  even  the  street, 
that  furnish  diversion  to  the  active  boy,  are  denied  the  girl.  Her 
life,  more  circumscribed,  is  more  liable  to  passive  suffering. 
Great  care  is,  therefore,  required  in  the  case  of  the  girl. 

In  such  cases  co-operation  of  a  skillful  physician  is  indis- 
pensable. A  delicate,  puny  woman  has  been  invalided  for  two 
years,  solely  by  the  shock  produced  upon  a  primarily  unstable 
nervous  system  from  a  prolonged  operation  in  regulation.  The 
weight  of  the  patient  should  be  obtained  at  the  time  the  appli- 
ances are  adjusted  and  noted  and  every  two  weeks  throughout 
the  operation. 

Success  in  dentistry  as  well  as  in  medicine  depends  to  some 
extent  on  the  mental  attitude  of  the  patient.  Interaction  of  mind 
and  body  may  be  aided  greatly  in  accomplishing  an  operation  or 
may  be  a  decided  drawback. 

Knowledge  of  human  nature,  quick  judicious  sympathy,  an 
agreeable  presence  and  tact  are  among  the  most  valuable  pos- 
sessions of  the  operator.  If  the  dentist  work  in  harmony  with 
the  laws  of  mental  and  physical  health,  half  is  gained.  With 
the  aid  of  these  qualities  the  more  likely  will  he  gain  the  co-oper- 
ation of  the  patient  and  guardian. 

Desire  for  correction  depends  somewhat  on  the  social  status 
of  the  patient,  sex  and  age.  The  poverty  stricken,  even  if  they 
have  a  decided  sesthetic  sense,  are  so  hampered  with  pressing 
considerations  of  a  more  urgent  nature  that  little  attention  is 
paid  to  irregularity.     With  the  well-to-do,  the  sesthetic  side  of 


SURGICAL    DIAGNOSES.  389 

life  assumes  larger  proportions  Beauty  is  of  the  greatest 
importance,  especially  in  women.  Their  lot  in  life  may  be 
materially  changed  by  an  attractive  mouth.  Society,  taking  these 
things  for  granted,  acts  upon  them.  The  dentist  is,  hence,  more 
likely  to  secure  the  co-operation  of  the  child  of  the  well-to-do. 
The  daughter  of  Dives  who  subjects  herself  cheerfully  to  the  tor- 
ture of  waist  compression  will  with  equal  readiness  and  more 
logic  subject  herself  to  the  irritation  of  correcting  a  deformed 
arch.  The  mouth,  with  its  ample  opportunity  for  display  in 
repose,  conversation  or  laughter,  suffers  less  from  the  ravages 
of  time  than  the  waist.  Mothers,  usually  alive  to  these  con- 
siderations, encourage  their  children  to  endure  the  strain.  Occa- 
sionally parents,  by  their  indifference  or  careless  remarks,  be- 
com.e  a  great  hindrance  to  the  dentist.  They  do  not  co-operate 
with  him  by  enforcing  wearing  of  appliances  and  regular  visits. 
The  dentist  should  determine  the  attitude  of  patients  and  guard- 
ian before  his  task  is  undertaken,  since  without  their  co-oper- 
ation his  best  efforts  will  be  thwarted  and  his  reputation  suffer. 

Taking  the  impression  of  the  mouth  and  jaws  is,  of  necessity, 
the  first  step  in  regulation.  The  position  of  the  teeth,  their  rela- 
tions to  one  another  and  the  conformation  of  the  jaws  can  be 
more  easily  studied  and  accurate  conclusions  more  readily 
deduced.  The  teeth  should  not  only  be  moved  to  their  proper 
places,  but  must  be  in  harmonious  relations  to  one  another. 
Otherwise,  they  tend  to  return  to  their  faulty  positions.  Their 
normal  relations  can  best  be  determined  by  studying  the  model. 

The  material  employed  in  taking  impressions  must  depend 
upon  the  shape  of  the  jaw  and  position  of  the  teeth.  If  the  teeth 
be  but  slightly  irregular  or  if  the  crowns  be  short  and  quite 
irregular,  plaster  of  Paris  should  be  used. 

If,  on  the  other  hand,  the  teeth  be  irregular  and  long  and 
the  arch  deep,  plaster  of  Paris  will  be  apt  to  adhere  to  the  teeth. 
In  such  cases  the  modeling  compound  should  be  used. 

Where  the  plaster  is  used  the  patient  should  occupy  an  ordi- 
nary chair,  as  the  head  is  lower  and  the  operator  has  better  con- 
trol of  the  patient.  The  clothing  should  be  protected  by  two 
towels  under  the  chin  and  a  newspaper  in  the  lap.  An  impression 
cup  large  enough  to  enclose  the  teeth  should  be  selected  and 
30  built  up  with  wax  that  it  will  extend  beyond  the  margin  of  the 


390  IRREGULARITIES    OF    THE    TEETH. 

gums.  The  center  of  the  cup  should  be  filled  with  soft  wax 
to  conform  to  the  palate ;  and  the  plaster  will  be  readily  carried  to 
all  parts  of  the  mouth.  The  finest  quality  of  plaster  should  be 
mixed  in  a  bowl  with  sufficient  water  to  make  a  mixture  of  the 
consistency  of  thick  cream  ;  addition  of  a  little  salt  will  hasten 
the  process  of  setting.  After  stirring  until  the  air  bubbles  have 
disappeared  and  the  plaster  has  begun  to  set,  the  cup  and  outer 
edges  should  be  filled  with  it. 

The  operator  should  stand  to  the  right  and  just  behind  the 
patient  with  the  left  arm  around  the  left  side  of  the  head  and 
'the  forefinger  inserted  into  the  mouth.  The  cup  should  be  car- 
ried to  the  mouth  with  the  thumb  and  forefinger  upon  the 
handle  and  the  middle  finger  in  the  center  to  steady  it.  After  it 
has  been  inserted  into  the  mouth  it  should  be  pressed  into  place 
with  a  rotary  motion  of  the  right  hand.  At  the  same  time  the 
lip  should  be  raised,  the  cheek  pressed  out  with  the  left  finger. 
When  the  cup  is  in  position,  it  should  be  held  firmly  with  the 
middle  finger  in  the  center  of  the  plate  against  the  teeth.  The 
head  should  be  inclined  toward  the  breast  to  prevent  the  plaster 
passing  back  to  the  fauces.  Should  the  stomach  become  dis- 
turbed and  vorniting  ensue,  it  can  be  evacuated  without  interfer- 
ing with  the  impression. 

Test  the  plaster  in  the  bowl  or  in  the  impression  cup  and 
when  it  will  break  with  a  clean  fracture  it  is  time  to  remove 
the  cup,  which  can  be  done  by  moving  the  cup  backward  and 
forward  with  the  right  hand  and  pushing  out  the  cheek  with  the 
fingers  of  the  left  hand  to  admit  the  air.  Having  placed  it  in 
the  upper  towel,  held  up  by  the  assistant,  carefully  examine 
the  mouth  and  if  pieces  of  plaster  be  seen,  put  them  in  the 
towel  on  the  proper  side  of  the  impression  to  save  time.  Set 
the  impression  carefully  away,  afterwards  arranging  the  pieces 
in  their  right  places. 

The  second  towel  is  for  the  purpose  of  removing  plaster  that 
may  remain  about  the  face. 

The  operation  should  be  explained  in  part  to  the  patient, 
who  otherwise  anticipates  serious  experience.  All  these  little 
details  should  be  strictly  attended  to  so  as  to  insure  perfect 
impression  at  the  first  sitting  and  save'  the  patient  the  annoy- 
ance of  later  applications. 


SURGICAL    DIAGNOSES. 


3.1 


In  taking  impressions  of  the  lower  jaw  the  patient  should 
sit  higher,  so  that  the  month  will  be  on  a  level  with  the  elbow 
of  the  operator,  w^ho  stands  in  front  of  the  patient.  The  fingers 
of  the  left  hand  should  push  out  the  cheeks  and  lips  while  the 
cup  is  rotated  into  place  with  the  right  hand.  The  first  and 
second  fingers  of  each  hand  should  rest  upon  the  cup  over  the 
bicuspids  and  molars,  the  thumbs  under  the  jaw  on  either  side, 
tlius  holding  the  cup  firmly  in  place  until  the  plaster  sets,  which 
should  then  be  removed  and  placed  in  the  towel  as  before.  After 
a  few  minutes'  hardening  the  impression  should  be  placed  under 
running  water  to  remove  mucous,  saliva,  blood  or  particles  of 
plaster.     Should  the  plaster  be  broken,  the  pieces  can  be  placed 


Fig.  250. 

in  the  position  indicated  by  the  arrangement  on  the  towel,  and, 
when  perfectly  dry,  fastened  together  by  melted  wax.  A 
clean  separation  of  the  model  is  obtained  by  covering  it  with  a 
lather  of  soap  and  washing  ofT  the  surplus  or  by  coating  with 
shellac  and  oiling  to  prevent  sticking. 

Modeling  compound  is  employed  with  success  if  water  heated 
to  the  boiling  point  be  poured  into  a  bowd  containing  modeling 
compound.  The  compound  should  be  inserted  as  hot  as  it  can 
be  borne.  Enough  should  be  used  to  cover  all  parts  of  the 
teeth  and  jaws  when  it  is  forced  into  place.  The  impression 
cup  should  be  held  firmly  in  place  for  a  moment  and  a  towel 
saturated  with  cold  water  should  be  carried  at  all  parts  of  the 


392 


IRREGULARITIES    OF    THE    TEETH. 


mouth  to  chill  the  compound.  Impression  cups  (Figs.  250  and 
251)  should  be  used  in  cases  of  irregularities.  The  compound 
loses  elasticity  by  boiling.  The  surface  of  the  impressions 
should  be  oiled,  thus  preventing  the  compound's  sticking  to 
the  cast. 

To  obtain  the  model,  place  a  sufficient  quantity  of  water  in  a 
bowl  and  pour  in  plaster,  allow  it  to  settle  and  thus  prevent 
formation  of  air  bubbles.  Add  enough  plaster  to  make  it  of 
the  consistency  of  cream.  To  exclude  the  air  put  a  drop  of 
water  into  each  depression  made  by  the  teeth  in  the  impression 
and  add  a  small  additional  quantity  of  plaster.  On  tapping  the 
cup  upon  the  bench  the  plaster  will  fill  up  the  depression  with- 


Fig.  251. 


out  formation  of  air  bubbles.  The  surface  should  now  be  cov- 
ered with  plaster.  After  mixing  in  more  dry  plaster  to  make  it 
thicken,  fill  the  impression  full  and  place  it  upside  down  on  a 
glass  slide.  Then  build  out  the  model  until  even  with  the  impres- 
sion cup  and  allow  it  to  harden.  It  had  better  stand  from  twelve 
to  twenty-four  hours  so  that  it  may  be  thoroughly  hardened 
before  being  removed. 

Having  removed  the  impression,  trim  the  model  roughly. 
After  articulating,  trim  it  so  that  the  body  of  the  model  will  be 
parallel  with  the  line  of  the  teeth  and  made  presentable  for 
inspection.  Place  the  name  of  the  patient  and  the  date  of  begin- 
ning operation  on  the  surface  of  the  lower  model.    The  patient's 


SITRGICAT,    niAGNOSES.  3fl3 

initials  should  be  put  upon  the  Ujjpcr  ukxU'I.  After  this  the  sur- 
face should  be  varnished.  A  band  of  elastic  rubber  will  hold 
them  together.  An  articulator  of  brass  wire  (Fig.  252)  may 
be  made  for  holding  the  models  in  proper  positions  and  then 
preparing  them  for  easy  inspection.  The  upper  arms  and  spiral 
may  be  made  of  one  piece  of  wire,  No.  ]8,  U.  S.  gauge;  the 
lower  arms  from  another  piece  of  the  same  wire  passed  through 
the  spiral  and  bent  to  correspond  to  the  upper  arms.  The 
models  may  now  be  articulated  and  the  wire  arms  bent  to  meet 
the  upper  and  lower  surfaces.  The  surfaces,  after  being  sat- 
urated with  water  should  be  covered  with  plaster  and  the  arms 
united  to  the  model. 


Fig.  5i52. 

In  regulating  teeth  a  model  should  be  conveniently  placed 
so  to  improve  spare  moments  by  studying  the  physiologic  con- 
ditions of  the  teeth  before  arriving  at  conclusions  as  to  the 
pathology  of  the  case.  In  determining  the  character  and  extent 
of  a  deformity  a  criterion  is  necessary.  In  the  skull,  on  taking 
the  two  cuspids  for  the  starting  point,  the  arc  of  a  circle  is  found. 
On  dropping  a  line  from  the  cusp  of  the  cuspid  to  the  center 
of  the  wisdom  tooth,  the  posterior  part  is  seen  to  diverge  con- 
siderably from  the  central  line  (Fig.  253).  The  three  normal 
lines  of  the  dental  arch  are  seen. 

The  incisors  of  the  inferior  maxilla  should  close  inside  of 
the  superior  incisors.  The  buccal  cusps  of  the  bicuspids  and 
molars  should  occlude  at  the  center  line  or  sulci  of  the  superior 


39-1  IRREGULARITIES    OF    THE    TEETH. 

bicuspids  and  molars.  If  the  articulated  skull  be  placed  with 
the  buccal  surface  toward  the  observer,  a  gentle  curve  down- 
ward will  be  seen  from  the  cuspid  to  the  second  bicuspid,  rising 
then  until  the  wisdom  teeth. are  reached.  Fig.  254  shows  the 
relative  positions  of  the  teeth  in  the  jaw  and  their  relation  to 
one  another.-  Since  mastication  is  done  principally  by  the  bicus- 
pids and  first  molars,  these  teeth  should  articulate  perfectly. 
This  is  accomplished  by  the  tooth  of  one  jaw  interlocking 
between  two  teeth  of  the  opposite  jaw,  thus  providing  support 
and  surface.  The  points  of  the  cusps  of  the  superior  cuspids 
should  stand  at  the  point  of  occlusion  of  the  inferior  cuspid  and 
first  bicuspid. 

If  the  arch  posterior  to  the  cuspids  be  uniform  and  these 
teeth  be  regular  and  articulate  as  shown  in  Fig.  254,  they  should 


not  be  interfered  with  for  slight  deformity  in  any  of  the  six 
anterior  teeth.  The  cuspids  may  be  widened  laterally  to  make 
all  the  room  needed.  When  this  is  accomplished  and  the  deform- 
ity corrected,  the  teeth  in  the  arch  will  adjust  themselves  prop- 
erly. If  the  irregularity  be  complicated  and  more  room  be 
required  than  can  be  obtained  by  extending  the  cuspids,  it  is  best 
to  enlarge  both  arches,  which  will  give  all  the  space  needed. 
The  changing  of  a  well-articulated  set  of  teeth  so  that  the  cusps 
of  the  opposite  teeth  will  strike  is  an  unpardonable  error. 

The  arch  of  the  superior  and  inferior  maxilla  should  have 
a  diameter  of  sufificient  width  to  prevent  an  impression  of  the 
teeth  on  the  sides  of  the  tongue.  Any  deviation  of  the  jaws 
or  teeth  from  this  outline  is  a  deformity  which  should  receive 
the  attention  of  the  dentist. 


SURGICAL    DIAGNOSES.  395 

With  this  standard  in  mind  the  model  will  reveal  certain 
deformities.  Careful  consideration  will  show  that  one  of  two 
conditions  exist;  either  the  teeth  arc  in  a  crowded  and  irregu- 
lar condition  inside  of  the  proper  line  or  they  are  isolated  and 
irregular  outside.  In  the  majority  the  irregularity  involves  the 
teeth  anterior  to  the  first  permanent  molar;  If  space  l)e  want- 
ing, the  question  will  arise  whether  to  enlarge  the  arch  by  force 
or  to  extract  one  or  more  teeth.  The  age  of  the  patient  will 
decide  this  question.  If  the  temporary  teeth  are  in  the  mouth, 
causing  irregularities,  they  must  be  removed.  When  the  removal 
of  the  second  teeth  becomes  a  necessity,  a  tooth  should  be 
selected  which  is  the  least  prominent  or  which  will  least  afifect 
the  expression.  In  selecting  teeth  for  removal,  each  case  must 
be  taken  as  a  law  unto  itself,  requiring  its  own  special  treat- 
ment.   A  good  rule  is  to  retain,  if  possible,  the  six  anterior  teeth. 


Fig.  254. 

As  the  cuspids  on  the  upper  jaw  are  the  most  prominent  and 
give  expression  to  the  face,  they  should  not  be  removed.  If 
a  tooth  must  be  sacrificed,  the  selection  lies  between  the  first  or 
second  bicuspid  and  the  first  molar. 

If  it  be  found  that  teeth  are  so  decayed  that  the  roots  cannot 
be  filled  and  the  crowns  replaced  with  artificial  ones  (at  the  age 
of  twelve  or  thirteen  years,  the  first  permanent  molar  is  often 
decayed)  those  affected  should  be  extracted.  This  was  the  case 
in  the  upper  teeth  of  a  girl  fourteen  years  of  age  (Fig.  255). 
Here  the  bicuspids  had  advanced  so  far  forward  that  there  was 
insufificient  space  for  the  cuspid  to  come  down  into  place.  Upon 
examination  it  was  found  that  the  first  bicuspid  upon  the  left 
side  and  the  first  permanent  molar  upon  the  right  side  were 
badly  decayed.  It  was  easy  to  decide  which  teeth  should  be 
sacrificed.    Tiie  cuspid  upon  the  left  side  came  into  place  with- 


396 


IRREGULARITIES    OF    THE    TEETH. 


out  assistance.  The  bicuspids  upon  the  right  side  were  carried 
back  and  the  right  cuspid  came  into  place.  The  first  perma- 
nent molar  has  most  often  been  extracted  without  sufficient 
cause.  Since  this  tooth  serves  an  important  purpose  in  mastica- 
tion on  account  of  its  broad  surface  and  large  long  roots,  it 
should  be  retained  if  the  crown  be  in  a  fair  state  of  preserva- 
tion. It  has  served  for  six  years,  which  fact,  in  connection  with 
its  solidity  in  the  jaws  and  its  central  position,  argues  for  keep- 
ing it. 

Upon  examining  tlie  models,  it  is  occasionally  found  that  the 
articulation  posterior  to  the  cuspids  is  perfect,  nearly  approxi- 
mating the  centrals  and  the  laterals  locked  inside  or  outside  of 
the  arch.     Whether  sound  or  decayed,  it  may  be  best  in  such 


Fig.  255. 


cases  to  remove  one  or  both  laterals.  The  general  appearance 
of  the  teeth  will  not  be  injured  by  this  treatment.  Dr.  Guilford^ 
describes  two  cases  of  this  kind  presented  to  him  in  one  year  for 
the  reduction  of  prominence  in  the  superior  front  teeth.  In 
each  case  there  was  a  broken  or  badly  diseased  right  central 
that  was  past  hope  of  redemption.  In  these  cases  it  did  not  hap- 
pen particularly  amiss,  since  extraction  of  the  roots  afforded 
room  for  drawing  in  the  remaining  five  teeth,  thus  easily  reduc- 
ing the  deformity  and  at  the  same  time  closing  the  space  made 
by  their  loss.  The  appearance  of  the  patient  in  each  instance 
was  greatly  improved.  The  absence  of  even  so  large  a  tooth  as 
the  central  was  hardly  noticeable. 

1  American  System  of  Dentistry. 


SURGICAL    DIAGNOSES.  3U7 

In  another  case,  a  girl  eleven  years  of  age  had  lost  a  right 
superior  central  incisor  through  a  fall  from  a  swing.  Two  days 
after  the  accident  and  when  the  tooth  had  been  mislaid  or  thrown 
away  she  was  brought  for  treatment.  Two  methods  of  remedy- 
ing the  difficulty  suggested  themselves  to  Dr.  Guilford.  One 
was  wearing  of  an  artificial  tooth,  the  other  drawing  the  teeth 
together  to  close  the  space.  The  latter  plan  was  successfully 
carried  out.  Unfortunately,  as  there  had  been  no  protrusion 
formerly  and  as  there  was  contraction  afterward,  the  superior 
teeth  no  longer  overlapped  the  lower  ones  but  met  them  edge 
for  edge,  thus  giving  the  upper  jaw  a  flattened  appearance,  in 
itself  a  deformity.  The  patient  was  saved  the  annoyance  of 
wearing  an  artificial  tooth,  but  her  facial  expression  was  injured 
in  consequence.  In  the  large  proportion  of  cases,  where  the 
anterior  teeth  are  crowded  and  the  cuspids  are  too  far  forward 
or  are  outside  or  inside  of  the  arch,  the  first  bicuspid  should 
be  extracted  on  one  or  both  sides.  Removal  of  these  teeth 
gives  sufficient  room.  The  operation  is  not  prolonged  as  would 
be  the  case  were  the  second  bicuspids  or  first  permanent  molars 
removed.  In  this  way  the  anterior  teeth  can  be  brought  into 
place  with  little  or  no  extra  space. 

Irregularities  of  the  lower  teeth-,  especially  of  the  inferior 
incisors,  are  often  seen.  If. the  articulation  be  normal  in  the 
posterior  part  of  the  mouth,  almost  any  of  the  incisors  that 
are  out  of  position  may  be  removed.  They  resemble  each  other 
so  closely  in  size  and  shape  and  are  so  nearly  concealed  by  the 
lip  their  loss  W'ill  not  be  observed.  The  operator  should  be 
particularly  careful  in  deciding  the  mode  of  treatment,  since  an 
actual  increase  of  the  deformity  may  be  produced  by  a  hurried 
operation.  In  one  case,  a  girl  of  ten  years  of  age,  a  central 
incisor  was  removed  and  the  muscles  of  the  Hp  together  with 
lateral  pressure  of  the  adjoining  teeth  pushed  against  the  cus- 
pids, forcing  the  incisors  into  a  crowded  condition,  thus  pro- 
ducing a  V-shaped  arch.  It  was  ascertained  that  the  articulation 
of  the  posterior  teeth  was  not  perfect.  It  has  been  advised  to 
remove  a  corresponding  tooth  on  the  opposite  side,  where  want 
of  room  compels  the  removal  of  a  tooth  in  the  anterior  part  of 
the  mouth.  It  is  claimed  that  there  is  danger  of  the  incisor  mov- 
ing by  the   median  hne  when  a  tooth  from  one  side  only  is 


398  IRREGULARITIES    OF    THE    TEETH. 

extracted.  It  has  been  found,  however,  that  when  a  tooth  is 
removed  back  of  the  cuspids  the  lateral  pressure  is  seldom  suffi- 
cient materially  to  move  the  incisors.  Cases  occur  in  which  the 
cuspids  on  the  lower  jaw  may  be  removed  without  injury  to 
contour  or  appearance.  It  is  frequently  better  to  do  this  than  to 
extract  a  lateral  incisor  or  first  bicuspid  and  try  to  bring  the 
cuspid  into  the  arch.  The  bone  is  so  dense  that  unusual  pressure 
is  required  to  produce  absorption.  This  can  be  done,  if  neces- 
sary, by  cutting-  away  the  alveolar  process  and  by  the  use  of 
screws. 

In  considering  the  bicuspids  the  one  which  is  the  most 
decayed  should  be  removed  if,  by  so  doing,  their  irregularity  can 
be  corrected.  Care  should  always  be  exercised  in  examining 
the  occlusion  before  a  bicuspid  is  extracted.     In  one  case  where 


the  two  upper  second  bicuspids  were  extracted  with  a  view  of 
relieving  the  crowded  condition  of  the  anterior  teeth,  the  artic- 
ulation of  the  first  bictispids  was  such  that  adjustment  was  impos- 
sible. These  perfectly  interlocked  with  the  lower  teeth.  No 
relief  followed  and  the  only  way  to  correct  the  blunder  was  to 
move  the  first  bicuspids  back.  The  mistake  had  been  made 
by  following  blindly  what  was  vaguely  supposed  to  be  the  rule 
without  considering  the  requirements  of  occlusion. 

If  both  bicuspids  be  found  sound,  then  the  first  should  be 
chosen  if  the  anterior  teeth  are  crowded.  This  makes  room  for 
the  cuspid.  In  studying  the  model,  the  end  to  be  kept  in  view  is 
the  retention  of  the  teeth  in  place  after  they  have  found  their 
new  position  and  are  so  properly  articulated  that  they  will  hold 
one  another  in  place.     If  this  be  not  accomplished  the  action 


SURGICAL    DIAGNOSES.  399 

of  the  cusps  will  force  the  teeth  into  their  original  faulty  posi- 
tion. 

Nowhere  in  medicine  is  diagnostic  use  of  the  Roentgen  ray 
of  so  much  importance  as  in  dental  deformities.  Delayed  erup- 
tion, early  extraction,  abnormal  and  broken  roots  of  teeth,  loca- 
tion and  position  of  third  molars,  absorption  of  the  roots  of  teeth 
and  of  the  alveolar  process  around  the  roots  can  easilv  be  out- 
lined. All  of  these  lesions  more  or  less  affect  occlusion  and 
impair  mastication.  Before  the  X-ray  it  was  impossible,  as  is 
now  done,  to  outline  impacted  and  imbedded  teeth. 

\Mien  the  permanent  teeth  are  missing  or  have  not  erupted, 
I  usually  cut  down  upon  the  locality  and  explore  for  missing 
teeth.  This  is  easily  done  and  with  very  little  pain  to  the  patient. 
To  outline  direction  and  contour  of  the  tooth  is  difBcult,  how- 
ever. 

From  arrest  of  development  of  the  jaw,  roots  become  entan- 
gled or  fused  together,  as  in  the  case  of  the  cuspids  and  second 
and  third  molars.  Here  it  is  often  difftcult  to  determine  the 
best  course.  By  the  X-ray,  lancing,  probing  and  packing  cotton 
are  avoided.  By  the  X-ray  the  parts  are  shown  in  exact  out- 
line of  the  tooth,  its  root  and  their  relations.  The  necessity  for 
operations  upon  the  teeth  is  thus  earlier  seen  and  the  operation 
expedited.  Frequently  the  permanent  teeth  are  prevented  from 
erupting  for  want  of  room.  In  such  cases  the  delayed  tooth  can 
be  assisted  by  extracting  or  otherwise  making  room. 

While  it  is  comparatively  easy  to  obtain  perfect  skiagraph 
of  other  parts  of  the  body,  it  is  as  yet  somewhat  difficult  to 
obtain  good  skiagraphs  of  the  jaws  and  teeth.  The  reason  is 
the  difficulty  of  keeping  the  parts  quiet  during  the  process  of 
placing  and  retaining  the  plate  films  in  proper  position  in  the 
mouth.  In  certain  parts  of  the  mouth,  such  as  the  molar  and 
bicuspid  region  of  the  lower  jaw,  success  is  greater.  With  the 
anterior  teeth,  those  of  the  upper  jaw,  success  is  obtained  with 
difficulty.  If,  however,  the  vault  be  high  much  better  results 
can  be  obtained. 

The  best  work  that  has  been  as  yet  accomplished  is  that  done 
by  Dr.  C.  Edmund  Kells,  of  New  Orleans,  Dr.  J.  N.  M'Dowell, 
of  Chicago,  and  Dr.  Dwight  M.  Clapp,  of  Boston. 


400  IRREGULARITIES    OF    THE    TEETH. 

Dr.  Kells'2  method  is  as  follows :  "A  cast  is  made  of  the 
portion  of  the  mouth  to  be  skiagraphed  and  a  small  piece  of 
modeling  compound  molded  over  the  crowns  of  the  teeth 
thereon.  A  piece  of  aluminum,  this  metal  being  almost  trans- 
parent to  the  rays,  of  about  26  or  28  gauge,  is  cut  to  the  desired 
size  and  shape  and  bent  to  fit  the  cast  as  well  as  possible.  This 
is  slotted  along  the  edge  toward  the  crowns  of  the  teeth  and 
thereby  attached  to  the  modeling  compound  above  referred  to. 
This  forms  a  convenient  little  film  holder,  which  when  placed 
in  the  mouth  will  allow  the  patient  to  close  the  teeth  upon  it 
and  thus  hold  it  securely  in  position,  without  danger  of  its  mov- 
ing for  a  much  longer  time  than  is  necessary  to  take  the  picture. 

The  next  step  is  to  cut  the  plate  or  celluloid  film,  whichever 


is  to  be  used,  to  the  proper  size  and  envelop  it  neatly  in  black 
paper,  gluing  down  all  the  edges  with  paste  and  securing  it  to 
the  plate  holder  by  two  or  three  small  aluminum  clamps. 

This  is  all  that  is  usually  necessary,  but  if  it  is  deemed  advis- 
able to  protect  this  from  moisture,  as  is  sometimes  the  case, 
more  especially  for  lower  teeth,  then  the  black  envelope  is  cov- 
ered with  thin  tin  foil  or  waterproof  paper  neatly  pasted  down, 
care  being  taken  not  to  have  the  foil,  if  that  is  used,  doubled 
upon  the  side  to  be  exposed.  While  this  may  appear  to  be  a  long 
process,  it  is  quickly  accomplished  and  the  invariably  satisfactory 
results  obtained  w^arrant  the  trouble  taken. 

The  patient  is  then  seated  in  a  chair  with  a  photographer's 

2  Dental  Cosmos,  Oct.,  1899. 


SURGICAL    DIAGNOSES.  401 

head  rest  to  hold  the  head,  the  Tesla  screen,  to  be  described 
later,  put  in  place,  the  tube  brought  to  about  ten  or  twelve  inches 
from  the  face  and  placed  so  as  to  throw  the  best  shadow  of  the 
parts  upon  the  film.  The  length  of  exposure  depends  upon 
the  thickness  of  the  parts  to  be  penetrated,  the  working  condi- 
tion of  the  apparatus  and  the  distance  of  the  patient  from 
the  tube,  the  time  being  proportional  to  the  square  of  the  dis- 
tance. 

From  sixty  to  ninety  seconds  are  necessary  for  ordinary  cases, 
ranging  perhaps  up  to  one  hundred  and  twenty  seconds  for  third 
molars  in  heavy  jaws,  while  twenty  to  forty  seconds  are  suffi- 
cient for  some  favorable  cases  in  thinner  bones. 

Fig.  256  shows  a  case  in  practice  of  an  unerupted  bicuspid 


Fig.  258. 
M'Dowell. 

taken  in  forty  seconds.  Fig.  257  shows  a  case  of  normal  teeth 
taken  in  twenty  seconds." 

Dr.  J.  N.  M'Dowell  recommends  the  following  method : 
'Tn  taking  X-rays  of  the  teeth  it  was  found  impossible  to  con- 
veniently cut  glass  sensitive  plates  to  correctly  fit  the  different 
parts  of  the  mouth  without  the  spoiling  of  many  plates.  To 
overcome  this  difficulty,  it  was  necessary  to  have  something 
that  could  be  easily  cut  and  shaped  to  fit  the  mouth  for  each 
occasion  and  at  the  same  time  transmit  light  as  a  negative  in 
making  photographs.  Celluloid  prepared  with  sensitive  chem- 
icals has  been  found  to  answer  this  purpose  best. 

No  special  preparation  of  the  mouth  in  the  way  of  washes, 
etc.,  is  necessary,  as  the  plate  is  protected  by  a  covering.    Cut  a 

27 


402  IRREGULARITIES    OF    THE    TEETH. 

piece  of  cardboard  to  fit  the  part  of  the  mouth  that  is  to  be  photo- 
graphed. In  the  dark  room  lay  the  cardboard  on  the  sensitive 
celluloid  plate  and  cut  to  the  same  shape.  Figs.  258  and  259, 
etc.,  of  the  X-ray  pictures  show  the  original  shape  of  the  cut 
celluloid.  This  is  then  wrapped  in  black  paper  to  protect  the 
plate  from  light  and  the  moisture  of  the  mouth.  The  head  is 
so  placed  as  to  be  immovable  and  the  sensitive  celluloid  placed 
in  the  mouth  directly  back  of  the  teeth  to  be  taken.  The  usual 
time  of  exposure  is  about  a  minute  with  Crookes'  six-inch  tube. 
This  tube  should  be  stationed  sonie  six  or  eight  inches  above 
and  in  front  of  the  teeth  to  be  taken,  in  order  to  secure  the  out- 
lines of  the  roots.  If  the  tube  is  held  directly  opposite  the  teeth 
the  roots  are  not  taken,  as  the  plate  cannot  be  inserted  high 
enough,  owing  to  the  shape  of  the  roof  of  the  mouth. "^ 

An  important  consideration  in  the  regulation  of  teeth  is  the 
pecuniary  reward.  The  dental  specialist  should  have  so  pre- 
pared himself  that  he  fully  understands  and  appreciates  the 
requirements  of  any  case  which  he  may  undertake  to  correct. 
This  wall  take  much  time  and  anxious  thought,,  for  which  he 
should  receive  just  reward.  A  thorough  understanding  as  to  the 
proper  remuneration  should  be  established  before  anything  is 
done. 

The  models  of  the  jaws  should  be  carefully  examined.  The 
temperament  and  disposition  of  the  patient,  as  well  as  the  ossific 
condition  of  the  jaws,  should  be  considered  and  minutely  exam- 
ined. It  frequently  happens  that  mouths  exhibiting  very  similar 
deformities  on  account  of  mental  and  physiologic  idiosyncrasies 
and  dififerences  in  density  of  tissue,  require  different  treatment 
to  accomplish  favorable  results.  After  these  preliminaries  have 
been  carefully  arranged  as  correct  an  estimate  as  possible  should 
be  made  (and  at  the  best  it  can  but  approximate)  of  the  expense 
of  regulation  and  retention  in  proper  position. 

At  this  juncture  before  operation  is  begun  a  thorough  under- 
standing should  be  established  between  the  operator  and  the 
parent  or  guardian  as  to  approximate  cost  of  the  work.  It  is 
well  not  to  be  too  definite  since  it  frequently  happens  that  the 
operation  requires  very  different  appliances  and  consumes  more 

3  Dental  Cosmos,  March,  1900. 


SURGICAL    DIAGNOSES.  403 

time  than  was  at  first  anticipated,  in  which  case  the  operator 
should  be  rewarded  for  his  unexpected  labor.  Or,  the  opera- 
tion may  be  completed  in  a  much  shorter  time  than  was  antici- 
pated, in  which  event  a  proper  regard  for  the  patient's  rights 
should  prompt  a  reduction  in  the  fee.  A  medium  and  a  maxi- 
mum ])rice,  therefore,  should  be  agreed  upon  before  the  opera- 
tion is  undertaken.  Conspicuous  among  the  difficulties  which 
come  with  regulation  is  first  to  persuade  the  patient  to  submit 
to  the  annoyance  of  wearing  the  appliance ;  secondly,  to  impress 
upon  the  patient  the  necessity  of  being  prompt  and  faithful  in 
visits  to  the  dentist's.  Not  appreciating  the  importance  of  these 
operations,  patients,  and  especially  children,  frequently  become 
discouraged  and  are  anxious  to  abandon  the  treatment  before  it 
is  completed.     The  parent  too  often  sympathizes  with  the  child 


Fig.  259. 
M'Dowell. 

and  without  regard  for  the  labor  or  expense  which  the  dentist 
has  assumed  or  the  real  interest  of  the  patient  abandons  the 
operation.  The  dentist  is  left  without  remuneration,  although 
up  to  this  point  he  has  carried  out  his  part  of  the  contract.  To 
secure  the  continued  co-operation  of  the  patient  and  parent  until 
the  completion  of  the  operations,  it  is  justice  to  the  dentist  that 
he  should  demand  and  receive  at  least  one-half  of  the  proposed 
fee  before  the  w^ork  is  begun.  With  this  money  invested  in 
the  operation,  the  parent  will  be  loth  to  allow  the  case  to  be 
abandoned  before  it  is  finished. 

The  dentist  with  due  regard  to  the  comfort  and  good  of  his 
patient  should  do  all  possible  to  expedite  his  operation,  so  that 
suffering  and  expense  may  be  as  light  as  possible.     All  should 


404  IRREGULARITIES    OF    THE    TEETH. 

be  done  with  an  intelligent  understanding  of  the  physiologic 
and  pathologic  conditions  under  care.  The  patient,  by  obedience 
to  the  dentist's  instructions,  can  facilitate  the  correction,  which 
will,  of  course,  greatly  reduce  the  expense  of  the  operation. 
Here  as  elsewhere  in  surgery  it  is  better  not  to  give  too  minute 
details  as  to  plans  to  be  followed  and  the  appliances  used,  since 
it  frequently  happens  that  the  most  carefully-planned  procedure 
has  to  be  varied  during  the  operation.  In  this  case  disappoint- 
ment and  dissatisfaction  may  be  engendered  in  the  mind  of  the 
patient  with  a  suspicion  as  to  the  dentist's  ability  to  accomplish 
the  results  at  first  promised. 


CHAPTER  XXXI. 


PATHOLOGIC  AND  PHYSIOLOGIC  CHANGES. 

The  chapter  upon  the  Alveolar  Process  dwelt  minutely  upon 
development  and  absorption  in  its  relation  to  eruption  and  loss 
of  the  teeth,  showing  that  the  process  was  solely  for  the  purpose 
of  supporting  the  teeth  while  in  place  and  finally,  after  they  have 
been  removed,  it  is  forever  lost.  This  structure,  being  transitory, 
the  osteoblasts  and  osteoclasts  are  always  present  to  build  up 
or  tear  down  structure  as  may  be  required  by  the  exigencies  of 
environment.  The  rapidity  with  which  the  cells  act  depends  to 
a  great  extent  upon  the  age  of  the  individual  and  condition  of 
the  system.  The  osteoblasts  and  osteoclasts  are  necessarily 
more  active  in  periods  of  growth.  This  is  due  largely  to  the 
vascularity  and  w^mt  of  -density  of  bone  structure. 

In  the  evolution  of  man,  the  face  is  constantly  undergoing 
change  and  the  jaws  are  growing  smaller.  The  alveolar  process 
being  a  transitory  structure  is  necessarily  unstable,  hence  here 
the  osteoblasts  and  the  osteoclasts  are  quickly  and  readily  set  in 
action.  Absorption  often  is  of  slow  development,  but  once  estab- 
lished, light,  constant  or  intermittent  pressure  makes  way  for 
the  advancing  tooth. 

The  teeth  are  constantly  changing  their  positions  in  the  jaw. 
absorption  and  deposition  of  bone  going  on  simultaneously  and 
continuously.  This  is  particularly  noticeable  at  the  first  eruption 
of  the  teeth,  and  again  from  the  twelfth  to  the  sixteenth  year. 
When  the  first  permanent  molar  has  been  removed,  the  second 
and  third  gradually  press  forward  and  fill  the  space. 

Teeth  that  are  erupted  out  of  their  position  will,  in  time, 
often  find  their  way  back  into  it :  when  molars  and  bicuspids  are 
lost  late  in  life,  the  anterior  teeth  being  forced  forward,  causes 
the  alveolar  arches  to  project.  When  the  anterior  teeth  come 
in  irregularly  they  rotate  their  way  into  place.  Through  these 
motions  of  the  teeth,  when  assisted  by  mechanical  devices  or 
removal    of    obstructions,    regulation    of   malposition   become.s, 

405 


406 


IRREGULARITIES    OF    THE    TEETH, 


simple ;  furthermore,  after  regulation,  the  teeth  may  be  firmly 
retained  in  their  relatively  new  positions  in  the  alveolar  process. 
Application  of  light,  constant  pressure  to  irregular  teeth, 
aiding  their  motions,  will  greatly  increase  absorption  and  repro- 
duction of  bone.  The  equable  reproduction  and  absorption  will 
depend  upon  the  amount  of  pressure  exerted  and  the  condition  of 
the  individual,  since  in  cachexise  disintegration  is  favored,  while 


Fig.  26o.:ii 

tissue  building  is  retarded.  This  notably  occurs  in  auto-intoxi- 
cation and  senile  absorption.  The  degree  of  pressure  and  the 
constitutional  condition  of  the  patient  must  therefore  be  taken 
into  account  in  operations  of  regulating.  When  the  alveolar 
arch  is  widened  laterally  as  a  whole,  and  the  force  distributed 
widely  upon  both  sides  of  the  jaw,  the  bones  yield  to  a  certain 
extent,  thus  spacing  the  teeth  equally  in  all  directions.  By 
absorption  of  the  old  and  by  deposition  of  the  new  bone  about 
the  teeth,  they  become  fixed  in  their  new  position.    The  degree 


PATHOLOOU:    AND    PHYSIOLOGIC    CHANGES.  407 

of  absorption  and  change  of  position  is  not  always  equal  in  all 

parts  of  the  tooth.    They  vary  with  the  direction  of  the  pressure. 

When  force  is  applied  to  the  crown  and  the  teeth  have  to  be 


1V4  inch  Beck  objective.    MagnificationlaboutjJox. — Xoyes. 

moved  considerably,  more  absorption  occurs  at  the  margin  of  the 
alveolus  than  at  the  apex.  The  mechanical  appHance  is  here 
the  power  and  apex  of  the  tooth  is  the  fulcrum.     The  power 


408 


IRREGULARITIES    OF    THE    TEETH. 


necessarily  acts  upon  the  margin  of  the  cavity  in  which  the 
tooth  is  imbedded.  The  tooth  may  be  said  to  move  hke  a 
spoke  in  a  wheel.    The  outer  part  of  the  crown  travels  relatively 


Fig.  262. 
A.  A.  Zeiss  obj.     Magnification  8C.5x.     }i  turn,  7  days. 

more  than  the  inner  part  or  apex.  The  gradual  diminution  in 
diameter  frorn  peck  to  apex  must  be  also  taken  into  consider- 
fitiop. 


PATITOI.OmC    AND    PHYSIOLOGIC    CHANGES. 


400 


If  the  pressure  be  gentle,  evenly  distributed  and  constant, 
pain  will  not  be  experienced,  when  the  teeth  have  once  begun 


Fis;.  263. 
A.  A.  Zeiss  obj.     Magnification  86.5x.     H  turn,  7  days. 

to  yield  in  the  proper  direction.  But  when  force  is  applied, 
removed  and  re-applied,  spasmodically  considerable  pain  neces- 
sarily results.    The  difference  between  the  results  of  steady  and 


410  IRREGULARITIES    OF    THE    TEETH. 

of  intermittent  pressure  is  observed  every  day  in  practice.  When 
teeth  have  been  separated  to  faciHtate  the  filhng  of  proximate 
cavities,  tooth  vibration  due  to  preparing  the  cavity  and  applying 
gold  produces  an  intense  pain,  relieved  by  inserting  a  wedge  to 
distend  and  steady  the  teeth  by  constant  and  equable  pressure. 
Individual  susceptibility  must  be  taken  into  account  since  the 
impressibility  to  pain  and  the  power  of  endurance  vary  with  race 
temperament  and  condition  of  the  patient.  After  twenty-five 
the  bones  contain  more  earthy  and  less  animal  matter  than  dur- 
ing the  formative  and  developmental  period.  The  constructive 
stage  having  passed,  the  teeth  are  moved  with  more  difficulty 
than  in  earlier  life.  With  increased  pressure  needed  to  effect 
absorption,  more  pain  and  inflammation  are  produced.  This  is 
particularly  the  case  when  alveolar  process  hypertrophy  is  pres- 
ent. This  pathologic  condition  is  very  common.  The  operator 
must  be  on  the  alert  to  discover  its  location  at  the  outset  of  the 
operation,  since  unusual  pressure  is  required  to  produce  bone 
absorption.  Cutting  away  the  alveolar  process  is  always  indi- 
cated here.  Strain  upon  the  nervous  system  of  the  patient  is 
thus  greatly  diminished. 

Until  a  few  years  ago,  lacunar  absorption  was  supposed  to 
be  the  only  form  of  bone  absorption.  In  a  discussion  of  Inter- 
stitial Gingivitis,  published  in  1899,  I  demonstrated  there  were 
four  forms  of  alveolar  process  absorption,  lacunar  or  osteoclast, 
halisteresis,  perforating  canal  and  osteomalaciary  (or  senile) 
absorption. 

The  question  had  naturally  arisen  as  to  what  gingivitis  occur 
from  movement  of  teeth?  To  determine  this,  experiments  were 
made  upon  dogs.  Impressions  of  the  mouths  were  taken  in 
modeling  compound.  Caps  of  German  silver  were  then  made 
for  the  cuspid  teeth.  A  jackscrew  was  soldered  to  the  caps  with 
soft  solder.  The  dog  was  then  securely  fastened  into  a  V-shaped 
box,  Fig.  260,  with  cotton  bandages.  When  chloroformed 
the  appliances  were  placed  upon  the  teeth  and  cemented  into 
place.  A  muzzle  was  then  placed  upon  the  head  and  the  fore- 
feet tied  to  prevent  removal  of  the  appliance.  The  muzzle  and 
bandage  were  removed  twice  a  day  for  the  purpose  of  feeding. 
The  screw  was  given  one-fourth,  one-half  and  one  full  turn 
every  evening.    The  screws  were  60  threads  to  the  inch.    The 


PATHOLOGIC    AND    PHYSIOLOGIC    CHANGES. 


411 


teeth  of  three  dogs  were  moved  1-240,  1-120,  and  1-60  of  an 
inch  respectively  per  day,  as  suggested  by  Farrar.^  At  the 
end  of  three  days  the  muzzle  and  leg  bands  could  be  removed, 


Fig.  i;64. 
A."A.  Zeiss^obj.     Magnification  173x.     14  turn,  7  days. 

the  dogs  having  become  accustomed  to  the  appliances.     This 
process   (whereby  the  screw  was  turned   one-fourth  and  one- 

1  Dental  Cosmos,  Vol.  XVIII,  page  23. 


412  IRREGULARITIES    OF    THE    TEETH. 

half  turn  per  day)  was  continued  for  seven  days.  In  those 
in  which  the  screw  was  turned  one  full  turn,  it  was  continued 
for  two  weeks.  The  object  was  to  set  up  pathologic  changes  in 
the  alveolar  process.  The  dogs  were  killed  at  the  end  of  the 
periods  mentioned.  The  jaws  were  placed  in  65  per  cent  alcohol 
for  twelve  hours,  then  in  absolute  alcohol  for  forty-eight  hours. 


Fig.  2(15. 
D.  D.  Zeiss  obj.     Ocular  No.  2.     Magnification  348.8x.     'A  turn,  7  days. 

'^hey  were  then  transferred  to  5  per  cent  nitric  acid  and  water. 
This  was  changed  every  two  days  for  a  week  or  until  the  tissues 
became  so  soft  as  to  be  easily  penetrated  by  a  pin.  They  were 
then  placed  in  running  water  to  remove  acid.  This  took  from 
twelve  to  twenty-four  hours.  The  tissues  were  then  placed  in 
65  per  cent  alcohol  six  hours ;  then  in  95  per  cent  six  hours, 


PATHOLOGIC    AND    PHYSIOLOGIC    CHANGES.  413 

and  then  in  absolute  alcohol  twenty-four  hours.  The  tissues 
were  then  imbedded  in  thin  celloidin  twenty-four  hours,  then  in 
thick  celloidin  twenty-four  hours.  They  were  then  mounted  on 
blocks  of  wood  and  hardened  in  80  per  cent  alcohol  from  six  to 
twenty-four  hours.  The  specimens  were  cut,  stained  in  haema- 
toxylin  eosin. 

The  second  illustration  (Fig.  261)  shows  the  normal  alveolar 
process  and  its  relation  to  the  peridental  membrane  and  adjoin- 
ing teeth. 

Third  (Fig.  262)  shows  the  condition  of  the  alveolar  process 
after  the  screw  has  been  turned  one-fourth  turn  for  seven  days. 
This  is  a  longitudinal  section  of  a  cuspid  tooth  with  the  edge  of 
the  alveolar  process  in  situ.  A  is  the  alveolar  process ;  C  the 
cementum  of  the  tooth ;  H  halisteresis ;  O  osteoclast  or  lacunar 
absorption;  P  the  periosteum. 

The  fourth  (Fig.  263)  is  a  cross  section  showing  cuspid  and 
lateral  incisor  with  alveolar  absorption  between  them.  A  alveo- 
lar process  ;  B  haversian  canals  ;  C  cementum;  E  large  medullary 
cavities  arising  from  absorption  of  the  trabeculse ;  H  halisteresis 
absorption  ;  P  peridental  membrane  ;  R  round  cell  infiltration. 

The  fifth  (Fig.  264),  under  high  magnifying  power,  shows 
A  alveolar  process ;  D  haversian  canals  with  round  cell  inflam- 
mation about  them  ;  E  large  medullary  cavities  due  to  absorption 
of  the  trabeculse ;  H  decalcified  bone  or  halisteresis ;  R  round 
cell  infiltration. 

The  next  sections  were  taken  from  a  dog  in  which  the  screw 
had  been  given  one-half  turn  every  day  for  seven  days.  Fig.  265 
illustrates  A  alveolar  process ;  O  osteoclast  or  lacunar  absorp- 
tion ;  P  peridental  membrane  with  round  cell  inflammation.  Fig. 
266  shows  A  alveolar  process ;  D  haversian  canals ;  H  halister- 
esis; P  peridental  membrane.  Fig.  267  illustrates  A  alveolar 
process ;  H  hahsteresis ;  O  osteoclast  absorption-;  P  peridental 
membrane ;  R  round  cell  inflammation ;  V  vessels  of  von  Ebner. 

The  sections  following  show  absorption  of  the  alveolar  proc- 
ess from  a  dog  in  which  the  screw  had  been  given  a  full  turn 
or  one-sixtieth  of  an  inch  every  evening  for  fourteen  days.  Fig. 
268  illustrates  A  alveolar  process ;  B  haversian  canals ;  E  large 
medullary  cavities  due  to  absorption  of  the  trabeculge ;  H  halis- 
teresis; VC  Volkmann's  perforating  canals. 


414 


IRREGULARITIES    OF    THE    TEETH. 


Fig.  269  under  a  higher  magnification  shows  A  alveolar  pro- 
cess ;  D  haversian  canals ;  VC  Volkmann's  perforating  canals. 
Fig.  270  (under  a  still  higher  magnification)  shows  A  alveolar 


Fig.  266. 
A.  A.  Zeiss  obj.     Magnification  86.5x.    %  turn, 


days. 


process ;  H  hahsteresis ;  O  osteoclast  absorption ;  R  round  cell 
infiltration ;  VC  Volkmann's  perforating  canal  absorption. 

If  so  many  pathologic  conditions  occur  in  the  alveolar  process 


'pathologic  and  physiologic  changes. 


415 


from  the  movement  of  the  teeth  and  in  interstitial  gingivitis, 
what  may  not  be  expected  in  tooth  eruption  and  in  healthy 
absorption  of  the  alveolar  process  after  teeth  have  been 
extracted  ? 

In  the  following  illustration  (Fig.  271),  taken  from  the  jaw 
of  a  voung  monkcv  who  died  from  burns,  the  inferior  cuspid 


Fig.  207. 
D.  D.  Zeiss  obj.    Ocular  No.  2.     Magnification  248.8x.     '.i  turn,  7  c3ays. 

teeth  were  pushing  their  way  through  the  alveolar  process,  but 
had  not  presented  themselves.  The  temporary  cuspids  were  still 
in  place.  It  shows  A  alveolar  process;  D  Haversian  canals;  E 
large  medullary  cavities  due  to  absorption  of  the  trabeculse; 
F  fibrous  tissue  resultant  on  halisteresis. 

In  moving  teeth  of  dogs  the  upper  jaw  alone  was  used.  Some 


416 


IRREGULARITIES    OF    THE    TEETH. 


teeth  of  the  lower  jaw  were  extracted  to  note  the  change  in  the 
alveolar  process  shown  by  the  following  illustrations.    The  teeth 


Fig.  2<*i. 
A.  A.  Zeiss  obj.    Magnification  86.5x.     Full  turn,  14  daj-s. 

had  been  extracted  for  seven  days.  Fig.  272,  under  low  power, 
shows  A  alveolar  process;  D  Haversian  canals  with  round  cell 
inflammation ;  O  osteoclast  absorption ;  VC  \'olkmann's  perfor- 


Pathologic  and  physiologic  changes. 


4lt 


ating  canal  absorption.  Fig.  273,  under  a  liigher  magnification, 
shows  A  alveolar  process ;  O  osteoclast  absorption ;  R  round 
cell  inflammation  ;  \"C  Volkmann's  perforating  canal  absorption. 


lig.   -MK 

D.  D.  Zeiss  obj.     No.  2.    Magnification  334.8x.     Full  turn,  14  days. 

In  Fig.  274  is  seen  A  alveolar  process;  B  Haversian  canal:  E 
large  medullary  cavity  due  to  the  absorption  of  the  trabecule; 

28 


418  IRREGULARITIES    OF    THE    TEETH. 

O  osteoclast  absorption ;  R  round  cell  infiltration.  In  Fig.  275 
is  seen  the  absorption  of  the  alveolar  process.  Interstitial  gingi- 
vitis is  observed  due  to  auto-intoxication.  In  extracting  the 
tooth,  the  detached  bone  was  also  removed  with  considerable 
fibrous  tissue  which  was  originally  alveolar  process.  D  dentine, 
C  cementum,  I  inflamed  fibrous  tissue,  J  alveolar  process,  O 
osteoclast  absorption. 

It  has  always  been  supposed  that  normal  absorption  in  the 
alveolar  process  under  normal  conditions  was  osteoclast  or 
lacunar  absorption  and  that  if  pressure  were  greater  than  the 
tissues  could  stand,  inflammation  set  in  and  absorption  ceased. 
Careful  study  of  the  process  of  absorption  revealed  that  different 
results  could  hardly  be  expected  in  tooth  movement.  The  sur- 
roundings of  the  alveolar  process  are  the  same.  Absorption  is 
the  same,  though  the  propelling  forces  be  dififerent;  interstitial 
gingivitis  irritation,  the  screw  pressure,  the  eruption  of  the  tooth 
and  the  extracted  tooth.  Were  a  tooth  implanted  into  the  alveo- 
lar process  of  a  human  being  or  a  dog  after  full  growth,  the 
same  methods  of  absorption  illustrated  will  occur  under  these 
difTerent  conditions. 

Absorption,  as  already  stated,  occurs  as  osteoclast  or  lacunar 
absorption,  halisteresis,  Volkmann's  perforating  canal  absorp- 
tion. As  a  normal  senile  function,  osteomalacia  or  senile 
'  absorption  produces  destruction  of  the  alveolar  process  and  loss 
of  the  teeth.  Waste  and  repair  are  so  adjusted  that  upon  the 
slightest  irritation  (even  tooth  extraction)  osteoclast  absorption, 
halisteresis  and  perforating  canal  absorption  occurs.  The  influ- 
ence of  extraction  on  inflammatory  conditions  was  carefully 
excluded  by  Dr.  M.  Herzog,  who  conducted  the  examinations, 
and  his  care  is  shown  in  the  absence  of  inflammation  in  the  peri- 
dental membrane.  Pressure  intensifies  all  forms  of  absorption. 
In  the  case  in  which  the  screw  was  given  a  full  turn  every  day  for 
fourteen  da3's  the  teeth  were  found  one-half  inch  apart.  Absorp- 
tion of  the  bony  process  was  well  marked.  Halisteresis  and 
perforating  canal  absorption  was  much  intensified.  When  force 
is  apphed  to  the  tooth  the  peridental  membrane  is  compressed 
and  the  blood  supply  is  cut  ofif  for  the  time  being.  The  osteo- 
clasts, because  of  the  change  in  the  blood  current,  are  set  to 
work.    Absorption  of  alveolar  process  occurs  not  only  adjacent 


PATTIOLOGIC     AND     lMIYSlOI,OOIC    CHANGES. 


419 


to  the  root  of  the  tooth  (as  shown  in  Fig-.  262),  but  also  in  the 
Haversian  canals  throughout  the  entire  process (Fig-.263).  Inter- 


Fig,  aro. 

D.  D.  Zeiss  obj.     Ocular  No.  2.     Magnification  353.48x.    Full  turn,  14  days. 

stitial  inflammation  is  immediately  set  up  in  the  arteries  running 
through  the  Haversian  canals,  producing  halisteresis.  Through 
the  walls  of  the  blood-vessels  round  cell  infiltration  occurs  into 


420 


IRREGULARITIES    OF    THE    TEETH. 


the  connective  tissue.     Remains  of  decalcified  bone  appear  in 
Fig.  263.     Frequently  the  irritation  and  inflammation  has  been 


Pig-.  271. 
A.  A.  Zeiss  obj.    Magnification  8G.5x. 


SO  severe  that  the  fibrous  matrix  is  likewise  destroyed  (Fig.  264). 
The  inflammatory  process  extends  throughout  the  vessels  of  von 
Ebner  (Figs.  267-8-9),  producing  Volkmann's  perforating  canal 


PATHOLOCIC    AND    PHYSIOLOGIC    CHANGES. 


421 


absorption.  The  same  types  of  absorption,  as  are  observed  in 
interstitial  gingivitis  occurred  here  under  different  conditions. 
Bone  building  is  so  much  slower  than  absorption  that  two  weeks 
did  not  suffice  to  show  osteoclasts  at  work. 

In  cases  of  regulating  late  in  life,  retentive  plates  must  often 
be  worn,  for  two  or  three  years,  after  the  malposition  of  the 
teeth  has  been  corrected  until  a  bone  deposition  is  sufficient  to 
hold  the  teeth  securely.  The  teeth  most  difficult  to  retain  are 
those  that  have  l)ccn  rotated  in  the  jaw,  since  these  have  a  len- 


FiK.  2Ta. 
Leitz  obj.     No.  .3.     Ocular  No.  .3.    Magnification  »0x. 

dency  to  return  to  their  original,  faulty  position,  through  con- 
traction of  the  fibrous  tissue  even  after  three  years.  By  dis- 
pensing with  the  retentive  plate  for  a  day  or  two  and  then 
re-inserting  it,  any  deviation  in  position  can  be  readily  noted. 
When  pressure  is  applied  to  a  tooth,  iritation  extends  through 
the  fibrous  tissue  to  the  periphery  of  the  bone  structure.  The 
osteoclasts  begin  to  form  in  the  fibrous  tissue  and  extend  into 
the    bony    tissue.      Fig.    262    shows    the    fibrous    tissue    and 


422  IRREGULARITIES    OF    THE    TEETH. 

alveolar  process.  Only  a  small  portion  of  the  peridental  mem- 
brane is  seen.  Absorption  of  the  alveolar  process  has  gone  on 
to  a  considerable  extent.  Only  a  small  portion  of  bone  in  the 
center  being  acted  upon  by  the  osteoclasts. 

Fig.  263  shows  the  peridental  membrane  and  the  fibrous 
tissue  extending  through  the  alveolar  process.  The  bone  is 
entirely  absorbed  except  a  small  portion  in  the  center.  Osteo- 
clasts are  seen  at  work  producing  absorption  of  the  remaining 
structure. 

In  rotation  of  teeth,  absorption  of  bone  rarely  takes  place. 
Pressure  of  the  peridental  membrane  causes  the  fibers  to  elon- 
gate and  take  the  direction  of  the  tooth.  In  making  a  reasonable 
pressure  upon  the  teeth,  the  earthy  substance  of  the  bone  is 
removed,  leaving  the  fibrous  tissue  intact.  The  fibrous  tissue 
of  the  bone  retains  the  blood-vessels  and  osteoblasts.  The  pres- 
sure upon  the  tooth  does  not  detach  the  peridental  membrane. 
The  application  of  force  either  in  straight  lines  or  rotation  causes 
the  fibers  to  stretch.  Remove  the  pressure  and  the  elasticity  of 
the  tissue  will  soon  return  the  tooth  to  its  original  position ;  when 
the  tooth  or  teeth  have  been  forced  to  their  new  positions,  fibrous 
tissue  is  developed  to  reinforce  that  which  has  been  injured  by 
stretching.  Osteoblasts  build  up  new  bone  tissue  and  in  this  way 
the  tooth  is  held  in  its  new  position.  To  accomplish  this,  the 
tissues  must  be  held  perfectly  still  by  retaining  appliances  upon 
the  teeth.  If  the  alveolar  process  has  obtained  its  growth  and 
the  fibrous  tissue  (trabeculas)  is  destroyed  the  chances  of  restor- 
ation are  meager.  In  any  case  the  normal  contour  will  not  be 
restored. 

In  the  light  of  these  experiments  and  the  ease  with  which 
inflammation  and  absorption  are  produced,  it  is  doubtful  whether 
(as  some  claim)  the  alveolar  process  is  ever  bent  into  a  new  posi- 
tion. In  any  case  should  the  process  yield  to  pressure,  absorption 
must  continue  until  the  pressure  is  relieved. 

Not  infrequently  in  children  whose  nervous  systems  are 
unstable,  constant,  steady  pressure  for  any  time  will  wholly 
unnerve  the  patient.  It  is  not  good  practice  to  cause  continuous 
pain  for  any  length  of  tinie,  by  forcing  the  teeth  through  the 
alveolar  process,  when  this  can  be  accomplished  by  a  much  more 
rapid  scientific  method  of  cutting  away  the  bone. 


PATHOLOGIC    AND    PHYSIOLOGIC    CHANCKS. 


423 


From  what  has  been  said  of  the  alveolar  process  in  its  absorp- 
tion and  its  terminal  structure  aspects,  it  is  evident  that  the  teeth 
cannot  be  corrected  without  pathologic  disturbances. 

While  other  forms  of  absorption  must  await  the  onset  of 
inflammatory  processes,  osteomalacia  or  senile  absorption  sooner 
or  later  ensues  in  every  individual.  This  from  the  unstable 
nature  of  the  alveolar  process  is  a  normal  absorption.  This 
absorption  is  readily  produced  from  shght  irritation,  like  heat, 
auto-intoxication,    drugs,    etc.      Osteomalacia    normally    occurs 


Fi.e.  273. 
Spencer  Proj.     U  inch.     Ocular   1  inch.     Magnification  200x. 

after  the  process  has  obtained  its  growth.  It  may,  however, 
occur  before  that  time  when  the  pathologic  factor  is  sufficient  to 
overcome  cell  building;  such  as  malnutrition,  drugs,  etc.  The 
alveolar  process  is  so  unstable  that  interstitial  gingivitis  may  be 
found  in  nearly  every  mouth,  more  especially  in  neurotics  and 
degenerates. 

Properly  to  correct  irregularities  requires  a  thorough  under- 
standing of  the  laws  of  degeneracy.    When  a  practitioner  prides 


424 


IRREGULARITIES    OF    THE    TEETH. 


himself  upon  the  rapidity  with  which  he  can  correct  irregulari- 
ties, his  methods  demonstrate  lack  of  knowledge  of  the  struc- 
tures upon  which  operations  are  done. 

Extended  force  applied  throughout  the  alveolar  process  will 
correct  the  ordinary  deformity.  If  the  force  be  so  great  as  to 
destroy  the  trabecute,  tissue  building  cannot  restore  the  process. 
If  great  but  not  steady  pressure  be  applied  and  if  nutrition  be 
poor,  the  alveolar  process  will  not  be  restored. 

Over  three    decades   ago   a   dental   professor   regulated   the 


Fig.  iU. 
Spencer  Proj.    k  inch.     Ocular  1  inch.     Magnification  200x. 

teeth  of  a  sixteen-year-old  girl.  This  (in  1870)  was  considered 
a  most  successful  operation.  So  pleased  was  the  teacher  that 
he  invited  the  students  to  his  office  to  examine  the  models  and 
results.  Four  years  after  the  girl  married.  She  was  under  my 
observation  till  her  death.  The  alveolar  process  was  never 
restored.  Interstitial  gingivitis  continued  as  long  as  she  lived. 
The  alveolar  process  absorbed  from  one-third  to  one-half  the 
length  of  the  roots  upon  all  the  teeth  and  they  never  became 


I'AIHOLOGIC    AND    PHYSIOLOGIC    CHANGES. 


425 


solid  in  tlu-  jaw.  They  were  always  sore  upon  mastication. 
Occasionally  pus  infection  occurred.  By  free  use  of  iodin,  inter- 
stitial gingivitis  was  nmch  reduced  as  pus  germs  were  thus 
destroyed.  Although  beautiful  and  with  beautiful  teeth,  irregu- 
larity and  alveolar  absorption  gave  her  an  elderly  appearance. 


Malnutrition  of  the  alveolar  process  should  preclude  an 
operation,  or  if  it  must  be  performed  slow,  steady  pressure  should 
be  used  to  prevent  excessive  interstitial  gingivitis.  Patients 
with  scrofulous,  syphilitic  or  tubercular  tendencies  should  be 
treated  with  great  consideration.  In  such  cases  one  or  two  teeth 
should  be  regulated  at  a  time. 

A  twelve-year-old  girl  in  delicate  health  had  her  teeth  regu- 


426  IRREGULARITIES    OF    THE    TEETH. 

lated  in  1891.  The  right  superior  central  and  lateral  were  rotated 
^o  that  their  palatine  surfaces  came  together.  The  cuspids  were 
separated  and  the  teeth  rotated  into  place.  The  lower  cuspids 
were  outside  the  arch.  The  arch  was  complete.  The  lower 
teeth  did  not  show  when  the  mouth  was  open.  The  cuspids  were 
removed.  At  twenty-two  health  was  much  improved.  Inter- 
stitial gingivitis  from  the  regulation  and  extraction  had  never 
been  diminished.  An  inflammatory  process  remained  in  cir- 
cumscribed area  the  depth  of  the  teeth. 

The  only  question  unsolved  in  regulating  teeth  late  in  life 
is  whether  the  results  are  proportionate  to  the  strain  upon  the 
system  from  the  methods  employed  and  from  effects  from  the 
ultimate  success. 

The  tendency  in  such  cases  is  toward  osteomalacia,  although 
the  other  forms  of  absorption  may  occur.  Permanent  absorp- 
tion may  then  ensue.  Some  years  ago,  a  forty-five-year-old  lady 
wished  to  have  a  right  superior  lateral  incisor,  which  occluded 
inside  the  lower  teeth,  brought  out  into  the  arch  with  the  other 
teeth.  Powerful  pressure  was  applied.  The  tooth  was  brought 
into  place.  Little  absorption  took  place.  The  outer  plate  of  the 
alveolar  process  was  split,  exposing  the  roots  of  the  right  central 
and  cuspid  teeth.  The  tooth  was  fastened  securely  and  the  bone 
united  with  considerable  osteomalaciary  absorption. 

Extended  operations  should  not  be  performed.  If  the  case 
be  successful  and  the  teeth  be  retained  in  their  position  for  the 
time  being  this  is  no  evidence  that  the  alveolar  process  will 
remain  through  life  or  that  the  next  ten  cases  will  be  successful. 
The  older  the  patient  the  greater  the  pressure  required,  the 
greater  the  amount  of  inflammation  set  up  and  the  less  chance 
of  success.  From  the  transitory  nature  of  the  jaws  and  the 
alveolar  processes,  density  of  bone  in  hypertrophy,  the  terminal 
structure  and  the  ease  with  which  inflammation  and  absorption 
ensue,  the  question  naturally  arises,  when  and  how  is  regulation 
of  teeth  justified. 

Cutting  away  of  the  alveolar  process  will  always  relieve 
excessive  pressure,  reduce  the  inflammation  to  a  minimum  and 
prevent  extensive  absorption.  Correction  of  the  teeth  at  all 
periods  produces  structural  change  in  the  alveolar  process.  The 
extent  of  this  ever  remains  a  predisposing  factor  to  interstitial 
gingivitis. 


CHAPTER    XXXII. 


SURGICAL  CORRECTIONS. 

Surgical  correction  of  deformities  of  the  jaws  and  teeth  in 
its  relation  to  dentistry  resembles  Orthopedic  Surgery  in  its 
relation  to  medicine.  Deformity  correction  implies  mechanical 
operation  upon  the  tissues  in  a  way  foreign  to  ordinary  dentistry 
and  hence  special  training  is  needed  for  its  practice.  The  oper- 
ator should  be  thoroughly  endowed  with  mechanical  ingenuity, 
familiar  with  mechanical  movements  as  well  as  versed  in  path- 
ology. 

Some  claim  that  fixed  systems  of  appliances  can  be  depended 
upon  for  the  purpose  of  correcting  a  given  line  of  cases,  that 
these  can  be  readily  applied  by  the  operator  and  the  correction 
will  proceed  successfully  and  rapidly.  This  is  but  partially  true. 
The  dentist  who  advances  such  a  doctrine  is  a  victim  of  the 
one-sided  bias  which  has  done  such  harm  to  science. 

The  opening  chapter  of  a  recent  work  states  that  "it  is  often 
asserted,  even  by  some  authoritative  writers  upon  the  treatment 
of  dental  irregularities  (Orthodontia),  that  no  fixed  system  of 
appliances  should  or  can  be  depended  on:  that  each  case  so 
differs  from  all  others  as  to  require  some  new  appliance  pecu- 
liarly suited  to  that  case,  and  that  only.     *     *     *     The  author 
believes  and  has  proven,  that  it  is  not  only  possible,  but  prac- 
ticable to  systematize,  classify  and  provide  ready-made  regulating 
appliances  reducing  them  to  few  simple  forms,  to  meet  by  their 
combinations  the  requirements  in  all  varieties  of  cases  susceptible 
to  treatment."    Centuries  of  experience  in  surgery  have  demon- 
strated that  appliances  must  be  adapted  to  the  case  and  not  the 
case  to  the  appliance.     This  is  particularly  true  of  dentistry 
where  results  must  depend  upon  the  educated  touch  rather  than 
the    appliance.      The    orthopedist   would    scoff   at   the    idea   of 
having   routine   appliances   always   on   hand   for   correcting  all 
deformities.     Certain  parts  may  be  kept  on  hand  for  certain 
fixed  forms,  but  even  these  must  be  adjusted  to  the  special  case. 

427 


428 


IRREGULARITIES    OF    THE    TEETH. 


That  the  same  law  exists  as  to  appHances  for  correctmg  deform- 
ities of  jaws  and  teeth  needs  no  demonstration. 

The  victim  of  such  teachings  frequently  fails  in  his  cases  by 
relying  too  much  upon  a  "system"  rather  than  upon  general 
principles.  One  kind  of  appliance  may  be  used  to  start  the 
operation,  but  the  skilled,  unbiased  operator  will  observe  that  a 
different  appliance  can  be  used  to  a  better  advantage ;  especially 
in  connection  with  one  already  in  use.  The  victim  of  a  "system" 
cannot  be  a  skilled  operator  because  of  mental  limitations 
thereon  resultant.  "Our  little  systems  have  their  day.  They 
have  their  day  and  cease  to  be." 


Fig.  276. 


Fig.  277 


The  constitution  and  health  of  the  patient  must  always  be 
considered.  An  appliance  theoretically  adapted  to  a  given  case 
may  be  wholly  unfit  because  of  the  patient's  physical  condition. 
An  appliance  suitable  to  one  period  of  life  will  not  be  to  another. 

In  order  to  work  in  the  shortest  time  and  with  least  incon- 
venience, knowledge  of  the  mechanical  forces,  the  powers  and 
limitations  of  each,  and  method  of  application  are  needed.  All 
forces  act  either  continuously  like  the  lever,  or  interruptedly 
like  the  screw,  but  in  either  case  their  action  diminishes  with  the 
yielding  of  the  tooth.  The  mechanical  powers  are  all  modifica- 
tions of  two  primary  principles ;  the  inclined  plane  and  the  lever. 
From  these  other  forces  are  derived,  thus : 


SURGICAL    CORRECTIONS. 


429 


The  Screw,  The  Inclined  Plane, 

The  Lever,  The  Wedge, 

The  rulley,  Wheel  and  Axle,  h^lasticity. 

Elasticity  plays  an  inii)ortant  ])art  in  the  application  of  force 


Fig.  278. 


in  regulating  teeth.  All  of  these  forces  have  their  places  in  the 
correction  of  deformities  of  the  jaws  and  teeth.  Appliances  can- 
not be  made  which  do  not  include  one  or  more  of  these  forces. 
All   the   forces   may   be   successfully   used   in   regulating   teeth. 


Fig.  279. 


Principles,  rather  than  systems,  should  be  taught  in  our  schools. 
Each  may  be  used  to  a  good  advantage  in  given  cases  when 
judgment  has  been  employed  in  selection  and  adjustment  of 
appliances  and  in  adopting  the  methods  of  using  them.     With 


430 


IRREGULARITIES    OF    THE    TEETH. 


these  laws  and  their  appHcations  firmly  fixed  in  mind,  the  opera- 
tor can  select  the  one  which  should  properly  be  applied,  or,  if 
more  than  one  is  needed,  can  so  combine  them  as  to  accomplish 
the  desired  result.  The  degree  and  line  of  force  required  have 
much  to  do  with  the  form  of  appliances  needed. 


Fig.  280. 

Every  appliance  for  regulating  the  teeth  aims  at  the  object 
to  exert  pressure  upon  the  teeth  to  be  moved.  An  appliance  for 
this  purpose  should  be  as  small  as  compatible  with  effectiveness 
and  strength.  It  should  be  so  constructed  it  can  he  applied 
inside  of  the  arch  in  such  a  manner  it  will  not  interfere  with 


Fig.  281. 

speech  or  mastication  and  can  be  removed  for  cleansing.  It 
should  give  as  little  annoyance  as  possible  and  should  not  neces- 
sitate frequent  visits  to  the  dentist  for  adjustment.  Whether  the 
teeth  are  to  be  forced  out  or  drawn  in,  there  is  always  to  be 
considered  a  body  to  be  moved  (the  tooth)  and  a  fixed  point 
of  resistance. 


SURGICAL    CORRECTIONS. 


431 


Study  of  the  model  does  not  always  determine  the  amount  of 
force  required  to  move  the  tooth.  The  model  should  be  studied 
but  not  to  neglect  care.  While  usually  a  point  opposite  can  be 
chosen  for  the  anchorage  of  the  appliance,  this  does  not  always 
hold  good.  Every  case  is  a  problem  in  itself.  The  point  of 
anchorage  must,  of  course,  afTord  greater  resistance  than  the 


point  to  be  moved.  To  find  such  a  point  is  sometimes  difficult. 
Such  is  the  case  where  a  cuspid  has  to  be  moved.  In  such  cases 
it  frequently  happens  the  dentist  finds,  to  his  chagrin,  he  has 
moved  his  point  of  resistance  rather  than  the  tooth.  Constant 
vigilance  must,  hence,  be  exercised  in  noting  occlusion.     The 


W 


W 


li 


A  A  A  A 


A 

B 

c 

D 

'A       ys 

E 

F 

I 

G 

fz 

n 

'A 

Fig.  -283. 

I 

i5< 

i^^ 

patient  should  be  asked,  at  each  sitting,  in  which  tooth  he 
sufifers  most  when  the  nut  is  turned.  It  is  often  found  expedient 
in  moving  teeth  that  afford  great  resistance,  like  central  incisors 
or  cuspids,  to  loosen  them  first  by  simple  wedging  with  orange 
wood,  or  even  cotton,  proceeding  slowly.  This  causes  slight 
inflammation,  then  absorption  of  the  alveolar  process  around 


432  IRREGULARITIES    OF    THE    TEETH. 

the  tooth  or  teeth  to  be  moved,  giving  these  teeth  a  decided 
advantage  when  force  is  appHed.  Thus  resistance  is  lessened 
and  the  tooth  or  teeth  to  which  the  appUances  are  attached  will 
now  afford  greater  resistance  in  proportion  that  at  first. 

Sometimes  a  plate  can  be  constructed  to  which  an  appliance 
for  moving  a  tooth  may  be  attached.  This  is  desirable  (i)  where 
there  is  not  a  tooth  conveniently  located  for  attachment;  (2) 
when  it  is  expedient  to  avoid  the  additional  irritation ;  (3)  when 
the  mechanism  is  such  as  to  require  it.  In  applying  the  appar- 
atus to  a  tooth,  its  position  in  the  jaw  should  be  observed  and 
the  inclination  of  the  root  or  roots  must  be  ascertained  to  decide 
whether  they  stand  perpendicularly  in  the  alveolar  process  or  on 
an  incline.  All  obstructions  should  be  removed  by  extraction 
or  by  lateral  pressure. 

The  force  should  be  applied  to  the  tooth  to  be  moved  either 


Fig.    284.  Fig.  285. 

at  right  angles  to  the  long  axis  of  the  root  (Fig.  276,  a,  b,  c),  or 
at  an  angle  of  45  degrees,  d,  b,  c.  By  these  means  the  tooth 
is  prevented  from  rising  from  the  socket.  The  position  of  the 
tooth  in  the  jaw,  the  density  of  the  alveolar  process,  the  length 
of  the  roots,  their  normal  or  abnormal  condition  and  length  of 
crowns,  all  require  consideration  in  deciding  amount  and  direc- 
tion of  force  to  be  used  without  elongating  the  tooth.  Drilling 
of  holes  in  natural  teeth  for  anchorage  is  practiced  by  some  repu- 
table dentists.  There  are,  however,  few  cases  that  cannot  be 
treated  by  securing  a  band  or  cap  of  thin  gold  or  platinum  to 
the  teeth  with  zinc  oxyphosphate,  in  which  band  holes  may  be 
drilled  or  hooks  or  loops  soldered  at  any  required  point. 

If  the  superior  maxillary  bone  be  examined  after  the  teeth 
are  removed,  the  outer  plate  of  the  alveolar  process  is  found 
much  thinner  than  the  inner,  which  is  backed  up  by  the  strong, 
thick  bone  of  the  hard  palate.     Upon  the  inferior  maxilla  the 


SURGICAL    CORRECTIONS. 


433 


outer  plate  of  bone  is  thinner  as  far  baek  as  the  second  bicuspicls 
and  the  inner  phite  is  thinner  at  the  parts  occni)ied  by  the  molars. 
The  inner  plate  is  thickest  between  the  second  bicuspids  upon 
either  side  and  is  reinforced  by  the  symphysis  and  gential 
tubercles.  The  external  i:)late  is  thickest  in  spaces  occupied  by 
the  molars  and  is  backed  by  the  external  oblicpie  ridge.  When 
the  soft  tissues  have  been  removed  from  the  superior  maxilla, 
it  is  not  uncommon  to  find  the  roots  of  sound,  healthy  teeth 
extending  through  the  outer  plate  of  bone.  After  the  teeth 
have  been  extracted,  absorption  of  the  outer  plate  takes  place 


Fig.  286. 


much  more  rapidly  than  of  the  inner  plate.  Absorption  of  the 
external  and  internal  plates  of  the  inferior  maxilla  goes  on  more 
uniformly  than  in  those  of  the  superior,  owing  to  a  more  even 
distribution  of  bone.  In  all  cases,  the  thick  or  hypertrophied 
alveolar  process  should  be  cut  away,  as  illustrated   elsewhere. 

In  the  application  of  force,  most  pressure  is  required  in  the 
direction  of  the  greatest  resistance.  Care  must  be  exercised 
in  directing  the  force  toward  the  weaker  parts  of  the  alveolar 
process. 

If  possible  the  force  should  be  uniform  and  steady,  but  this 
while  possible  with  certain  appliances  like  the  elastic  band,  liga- 

29 


434 


IRREGULARITIES    OF    THE    TEETH. 


tures  and  the  like,  is  impossible  with  the  screw.  All  forces  act 
either  slowly  and  constantly  like  the  above,  diminishing  in  their 
action  in  proportion  to  the  yielding  of  the  tooth,  or  else  they  act 
by  impulse  like  the  screw. 

The  force  exerted  should  be  enough  to  produce  absorption 
of  bone  with  slight  inflammation.  Too  rapid  movement  of  the 
teeth,  especially  when  patients  are  over  twenty  years  of  age, 
should  not  be  countenanced.  The  alveolar  process  may  be 
absorbed  to  such  an  extent  that  it  is  impossible  to  retain  the 
teeth  in  their  proper  places,  as  new  material  is  not  deposited. 
The  extensive  inflammation  resulting  from  the  excessive  force 
required  prevents  restoration  of  bone. 

The  inconvenience  and  unsightly  appearance  of  many  appli- 


Fig.  287. 


ances  required,  when  great  pressure  is  needed  to  move  certain 
teeth  (notably  cuspids,  upper  and  lower),  either  forward  or  back, 
is  another  objection.  Appliances  adjusted  to  the  head  are  so 
unsightly  and  embarrassing  that  not  infrequently  the  patient 
is  deterred  from  the  operation,  which  would  otherwise  have 
been  undertaken  could  some  method  be  adopted  which  would 
not  detract  from  personal  appearance. 

The  results  of  attachment  of  appliances  to  the  molars  for  the 
purpose  of  moving  the  cuspids  and  incisors  back  frequently 
chagrins  and  mortifies  the  operator  when  he  discovers  that, 
instead  of  the  molars  being  the  fixed  point  and  the  cuspids 
drawn  back,  the  reverse  has  occurred. 

One  most  difficult  problem  to  solve,  which  always  requires 


SURGICAL    CORRECTIONS. 


435 


extra  pressure,  is  that  when  the  inferior  alveolar  process  has 
become  excessively  developed,  carrying  the  incisors  upward 
until  the  cutting-edges  come  in  contact  with  the  mucous 
membrane  in  the  vault  of  the  mouth,  which  causes  proliferation 
of  osteoblasts  that  carries  superior  incisors  forward  (Fig.  12). 
Density  of  bone  often  makes  it  difficult  to  obtain  sufficient 
force  to  produce  the  absorption  of  this  tissue  required  to  bring 
the  teeth  back  into  place.  Probably  one  of  the  most  difficult 
operations  is  to  carry  a  cuspid,  which  is  erupting  in  the  vault 
of  the  mouth,  back  into  its  normal  position.  This  not  only 
requires  considerable  force,  but  time,  to  say  nothing  of  the 
difficulty  in  attaching  a  cap  for  a  point  of  resistance.     Rotation 


Fig.  288. 

of  the  teeth,  especially  the  incisors  and  cuspids,  is  frequently 
difficult,  if  not  impossible,  owing  to  insufficient  leverage. 

Alany  other  situations  present  themselves  to  the  operator  in 
his  practice  other  than  those  mentioned,  but  as  all  require  treat- 
ment in  the  same  manner,  only  the  most  difficult  cases  have 
been  considered.  After  an  appliance  has  been  adjusted,  no 
matter  of  what  nature  and  pressure  applied,  the  long,  tedious 
method  of  plowing  through  the  alveolar  process  (regardless  of 
the  density  of  the  bone)  by  absorption  is  pernicious  and  unscien- 
tific, not  to  speak  of  the  long,  tedious  days,  weeks  and  months 
of  suffering.  The  period  of  life  most  acceptable  for  the  correc- 
tion of  these  deformities  is  between  twelve  and  sixteen  years. 


436 


IRREGULARITIES    OF    THE    TEETH 


This  time  is  to  the  patient  the  most  critical  and  as  in  every  case 
they  are  degenerates  with  an  unstable  nervous  system,  the  great- 
est care  should  be  taken  not  to  subject  them  to  great  strain.  Ner- 
vous prostration  of  years'  standing  may  result,  and  patients  be 
permanently  injured  by  such  nerve-strain. 

To  obviate  excessive  pressure  as  well  as  unsightly  appliances 
I  have  for  many  years  proceeded  in  the  following  manner,  based 
upon  modern  principles  of  surgery :  This  method  consists  in 
removing  the  alveolar  process  in  the  line  of  travel  of  the  tooth 
to  be  moved,  leaving  a  small  amount  of  process  about  the  root 
of   the   tooth,    holding  intact  the  peridental   membrane.     This 


Fig.  289. 

is  accomplished  with  coarse-cut  Revelation  burs,  or  those  that 
will  cut  in  all  directions.  They  can  be  used  as  drills  in  certain 
conditions,  to  be  mentioned  later  on. 

If  the  cuspidf^  require  to  be  carried  backward,  make  an  appli- 
ance with  bands  about  the  first  and  second  molars,  with  caps 
upon  the  cuspids  and  a  bar  with  a  screw  nut  upon  the  end,  as 
recommended  by  Dr.  Farrar.  Extract  the  first  bicuspid  and 
adjust  the  appliance.  Then,  resting  the  hand  against  the  cuspid, 
cut  out  the  lingual  and  buccal  V-shaped  plate,  making  a  concave 
surface  of  the  alveolar  process,  as  illustrated  in  Fig.  o.'j'j. 

If  the  superior  incisors  are  to  be  carried  back,  cut  semi- 
circular spaces  just  posterior  to  the  teeth  to  be  moved  (Fig.  278). 
To  carry  a  cuspid  into  place  which  is  erupting  into  the  vault  of 


SURGICAL    CORRECTIONS.  437 

the  mouth,  remove  the  alveolar  process  in  the  direction  of  the 
line  of  travel  (Fig.  279). 

In  moving  teeth  laterally  by  a  jack-screw,  it  will  be  found 
that  not  infrequently  one  tooth  moves  faster  than  the  other.  To 
bring  both  to  their  proper  position,  cut  out  the  alveolar  process 
on  the  side  of  the  slowest-moving  tooth  and  both  will  come 
into  proper  position  (Fig.  280).  To  rotate  a  tooth,  cut  a  cir- 
cular groove  as  deep  as  possible  around  the  tooth,  leaving 
enough  process  to  hold  the  peridental  membrane  intact  (Fig. 
281).  In  this  manner  teeth  may  be  moved  very  rapidly  and 
without  much  pain.  This  should  always  be  done  by  means  of 
screws.     Bv  this  method  the  tooth  or  teeth  to  be  moved  are 


Fig.  :."jii. 

completely  under  control.  Any  of  the  teeth  in  the  mouth  may 
be  used  for  fixed  points  of  resistance,  thus  doing  away  with  all 
unsightly  appliances  outside  the  mouth.  When  in  place,  they 
should  be  anchored  in  the  usual  manner.  Antiseptic  washes 
should  be  used  from  time  to  time. 

Appliances  of  different  forces  should  be  discussed  in  order 
of  their  value  as  adjtmcts  in  the  correction  of  irregularities  of 
the  teeth.  Long  and  skilled  experience  has  shown  the  screw  to 
be  the  most  valued  instrument  for  this  purpose.  When  the 
appliance  is  once  adjusted  upon  the  teeth,  the  procedure  is  posi- 
tive and  simple,  causing  less  pain  and  producing  more  uniform 
results.     It  is  a  modification  of  the  inclined  plane  and  always 


438 


IRREGULARITIES    OF    THE    TEETH. 


requires  a  lever  for  the  purpose  of  turning  it.  It  may  be  used 
for  penetrating  wood,  like  a  thumb-screw,  a  gimlet,  etc.,  or  it 
may  be  used  as  a  moving  force,  as  in  raising  buildings,  or  in 
the  familiar  letter  press.  In  these  cases,  it  must  work  in  a  hollow 
cylinder  with  a  corresponding  thread  cut  inside  which  is  called 
the  female  screw,  or  nut.  When  the  screw  is  turned  in  the  nut, 
it  will  either  advance  or  recede.  With  the  screw,  the  power  pro- 
duces a  pressure  as  riiany  times  greater  than  itself  as  its  circum- 
ference is  greater  than  the  distance  between  the  threads. 

It  should  be  noticed  that,  unlike  other  mechanical  powers 
described,  the  screw  works  by  impulse,  each  turn  producing  an 
efTect  at  once  when  the  motion  is  ended.  This  kind  of  force  is 
of  peculiar  importance  to  the  dentist  since  it  is  positive  and 
when  properly  applied  can  always  be  depended  upon.     It  is  a 


Fig.  291. 

powerful  agent  in  widening  the  dental  arch ;  obstinate  cases 
yielding  readily  to  the  pressure.  Dr.  Farrar,  after  years  of  careful 
experience  with  dififerent  appliances  for  regulating  teeth,  more 
than  three  decades  ago^  set  forth  strong  reasons  for  using  the 
screw.  The  results  of  his  experiments  on  tissues  first  with 
elastic  and  afterward  with  the  screw  were  decidedly  in  favor  of 
the  latter. 

He  uses  the  screw  having  sixty  threads  to  the  inch.  The 
screw  is  turned  one-half  a  revolution  morning  and  evening,  thus 
advancing  the  nut  one-half  of  a  thread  or  T-120  of  an  inch  at  each 
operation,  or  1-60  of  an  inch  per  day.  This  rate  was  found  to 
produce  no  pain:  a  repetition  of  the  sense  of  tightness  was 
noticed  for  about  one  hour  after  every  advance  of  the  screw,  but 

1  Dental  Cosmos,  Vol.  XVIII,  page  13. 


SURGICAL    CORRECTIONS. 


439 


it  easily  was  borne  by  the  patient  and  produced  no  perceptible 
pain. 

His  method  and  experience  are  of  so  much  importance  that 
his  conclusions  deserve  quotation  and  emphasis.  "First,  That 
in  regulating  teeth,  the  traction  must  be  intermittent  and  must 
not  exceed  certain  fixed  limits. 

Second.  That  while  the  system  of  moving  teeth  by  elastic 
rubber  apparatus  is  unscientific,  leads  to  pain  and  inflammation, 
and  is  dangerous  to  the  future  usefulness  of  the  teeth  operated 
upon,  a  properly  'constructed  metallic  apparatus,  operated  upon 


Fig.  29-2. 

by  screws  and  nuts,  produces  happy  results  without  pain  or 
nervous  exhaustion. 

Third.  That  if  the  teeth  are  moved  through  the  gums  and 
alveolar  process  about  1-240  of  an  inch  every  morning,  and  the 
same  every  evening,  no  pain  or  nervous  exhaustion  follows. 

Fourth.  That  while  these  tissues  will  follow  an  advancement 
of  a  tooth  at  this  rate  (1-2.40  of  an  inch)  twice  in  twenty-four 
hours,  the  changes  being  physiologic,  yet,  if  a  much  greater 
pressure  be  made,  the  tissue  changes  will  become  pathologic.^" 

2  In  the  chapter  on  physiologic  and  pathologic  changes  the  experi- 
ments show  that  the  movement  of  the  teeth  is  always  pathologic. 


440 


IRREGULARITIES    OF    THE    TEETH. 


To  Dr.  Wm.  H.  Dwinell,  of  New  York,  the  profession  owes 
a  debt  for  the  introduction  of  the  jack-screw  as  a  powerful,  direct 
force  in  regulating  teeth.  The  following  cuts  (Fig.  282,  Nos. 
I,  2,  3)  are  the  original  jack-screws  introduced  by  Dr.  Dwinell, 
and  are  very  efficient  when  combined  with  rubber  plates.     The 


Fig.  -^93. 

screw  is  just  what  is  termed  in  mechanics  a  right  hand  thread 
with  a  single  nut.  The  distal  end  of  the  screw  is  made  conical 
that  it  may  be  directed  either  in  the  plate  or  band  around  the 
tooth  to  be  moved.  Nos.  4,  5,  6  show  Dr.  A.  McCullom's  inven- 
tion, and  are  called  compound  jack-screws.    They  are  made  with 


Fig.  294. 

right  and  left  thread,  with  nuts  to  correspond,  so  that  when 
adjvisted  they  will  expand  or  contract  if  a  lever  be  inserted 
in  the  holes  drilled  through  the  center  of  the  bar  and  moved  in 
either  direction.  The  length  of  the  bar  may  differ  according 
to  the  convenience  of  the  operator. 

Some  years  of  practice  showed,  however,  these  screws  were 


SURGICAL    CORRECTIONS. 


in 


not  only  ratlicr  l)unj;liiig  as  to  size,  but  that  the  threads  were 
too  coarse.  lM-e((ucntly  shorter  screws  could  also  be  used  to  an 
advantage.  For  some  years,  I  made  my  own  screws.  Later,  at 
my  suggestion,  they  were  made  by  the  S.  S.  White  Dental  Manu- 
facturing Company  (Fig.  283).      They  are  a  modification  of  the 


Fig.  295. 

Dwinell-McCullom  set,  and  in  every  respect  have  decided  advan- 
tages, one  of  the  special  features  being  that  the  nuts  are  hol- 
lowed out  at  the  ends,  thus,  readily  adapting  themselves  to 
the  crowns  of  the  teeth  and  preventing  their  slipping.  These 
screws  are  admirably  adapted  for  the  purpose  of  widening  or 
enlarging  the  dental  arches.    This  may  be  done  by  banding  two 


Fig.  296. 

or  more  teeth  upon  either  side,  lengthwise  to  the  dental  arch 
and  attaching  the  screw  in  a  position  which  will  give  uniform 
pressure.  The  location  will  depend  upon  the  shape  of  the  dental 
arch  and  the  location  of  the  teeth.  Another  method  I  fre- 
quently adopt  is  to  make  a  rubber  plate,  similar  to  that  of  Kings- 
ley's,3  vulcanize  it  only  sufificiently  to  make  it  springy  and  locate 

3  Oral  Deformities.  Fig.  46. 


442 


IRREGULARITIES    OF    THE    TEETH. 


the  modern  jack-screw  at  the  narrowest  point  or  where  the  most 
pressure  is  required.  The  difficuhy,  however,  in  using  plates 
is  that  after  the  teeth  have  been  pushed  beyond  the  perpendicular 
line,  the  plate  is  with  difficulty  kept  in  the  mouth.  I  overcome 
this  difficulty  by  cementing  bands  with  lugs  upon  them  to  the 
teeth.  By  so  doing  the  plate  cannot  slip  out  of  the  mouth.  Two 
teeth,  one  on  either  side,  may  be  carried  laterally  uniformly.  If 
one  is  progressing  faster  than  the  others  the  alveolar  process 
about  the  one  which  moves  the  slowest  may  be  cut  away.  In 
this  way  uniformity  of  distance  can  be  obtained. 

The  screw  should  always  be  used  in  combination  with  a  plate 
or  with  bands ;  otherwise  the  alveolar  process  and  gums  may  be 


Fig.  297. 

injured.  When  the  bicuspids  and  molars  stand  inside  of  the 
arch,  and  a  uniform  pressure  is  required  on  both  sides  of 
the  arch,  the  nut  is  prevented  from  working  into  the  gum  by 
placing  around  the  teeth  to  be  moved  platinum  bands  with  pro- 
jectives  soldered  to  the  edge  nearest  their  cervical  margins 
(Fig.  284). 

If  the  deformity  be  only  on  one  side  of  the  arch,  it  will  be 
necessary  to  obtain  either  a  fixed  point  opposite,  by  uniting 
three  or  four  teeth  with  bands,  and  thus  giving  a  strong  support, 
or  by  inserting  a  rubber  plate.  When  the  plate  is  finished,  a 
groove  may  be  cut  or  a  hole  drilled  to  hold  the  screw  in  place. 
The  screw  may  be  called  a  universal  force,  as  it  can  be  made 
to  force  teeth  in  or  out,  or  in  any  direction,  provided  a  fixed 


SURGICAL    CORRECTIONS. 


443 


point  can  be  obtained  from  which  to  work  the  screw.  Where 
the  roots  are  in  a  diagonal  position  in  the  jaw,  or  are  in  close 
proximity  to  other  roots,  the  screw  is  very  effective.  As  already 
shown,  holes  should  never  be  drilled  in  sound  teeth. 

The  shorter  jack-screws  are  very  efficient  when  a  tooth  is  out 


Fig.  298. 


of  line  and  it  is  possible  to  obtain  sufficient  space  by  forcing  a 
number  of  teeth  in  opposite  directions,  especially  where  great 
force  is  reqviired,  as  illustrated  in  Fig.  285. 

One  of  the  most  common  and  most  difficult  forms  of  deformi- 
ties which  require  treatment  and  considerable  thought  need  not 
now  be  described  in  detail,  since  its  many  complications  can  be 
reduced  to  simple  forms.     The  pathology  of  this  is  elsewhere 


Fig.  299. 

discussed.  There  are  many  other  deformities  of  the  teeth  in 
which  various  portions  of  these  appliances  may  be  used  with 
success.  Judgment  and  skill  of  the  operator  is  here  an  absolute 
necessity. 

A  rubber  plate  (Fig.  286)  is  placed  in  the  mouth,  fitting  the 
vault  and  of  sufficient  thickness  in  front  to  separate  the  posterior 


444 


IRREGULARITIES    OF    THE    TEETH. 


teeth,  in  order  to  lengthen  them  and  to  force  the  lower  incisors 
(which  alone  rest  upon  the  plate)  into  the  jaw.  This  was 
renewed  once  or  twice  to  give  additional  space  (Fig.  287).  When 
this  process  is  completed,  which  requires  from  three  to  nine 
months,  it  leaves  a  space  of  three-sixteenths  of  an  inch  between 
the  vault  and  the  lower  incisors  when  the  jaws  are  closed. 

After  the  models  are  obtained  and  before  extraction  of  teeth, 
the  operator  should  make  anchor  clamps  or  bands  and  adjust 
them  to  the  first  or  second  molars,  or  both.  Caps  should  then 
be  made  to  cover  the  cuspids,  which  are  to  fit  loosely  and  to 
extend  up  to  the  gum  margin  all  around.  This  is  necessary 
because  of  the  cone-shaped  crowns  and  the  great  force  required 


Fi>.  ?00. 

to  move  the  tooth,  the  caps  are  liable  to  be  pulled  off.  Tubes 
should  then  be  soldered  upon  the  caps  and  bands  to  accommo- 
date the  screws  and  nuts. 

Pending  the  making  of  appliances,  wedges  of  wood  or  rubber 
should  be  placed  between  the  second  bicuspids  and  molars  and 
first  and  second  molars  to  make  room  for  the  bands.  When  all 
is  ready,  the  first  bicuspids  should  be  removed  and  the  appliance 
fastened  into  place.  After  the  teeth  have  been  thoroughly 
cleaned  with  alcohol,  the  caps  and  the  bands  should  be  cemented 
and  the  bands  cemented  or  fastened  by  the  screws.  The  nuts 
should  be  turned  against  the  caps  about  six  hours  after  the  bands 
are  cemented.  Twenty-four  hours  should  elapse  before  pressure 
is  placed  upon  the  tooth  to  allow  the  cement  to  become  perfectly 


SURGICAL    CORRECTIONS. 


445 


hard.  With  a  good,  sharp, coarse  bur, previously  rendered  aseptic, 
cut  out  the  V-shaped  alveolar  jjrocess  on  buccal  and  lingual  sur- 
faces (Fig.  288), up  as  far  as  the  bicuspid  cavity  extends.  This  will 
relieve  the  operator  of  anxiety  as  to  forward  movement  of  the 
molars,  the  fixed  point,  and  will  not  require  the  patient  to  wear  a 
head  cap.  It  will  at  the  same  time  accomplish  the  work  in  less  than 
half  the  time  without  strain  upon  the  patient.  When  the  cuspids 
have  been  carried  back  as  far  as  required,  the  appliance  will 
answer  the  purpose  of  holding  them  in  position  until  the  rest 
of  the  operation  is  completed.  A  bar  should  then  be  fitted  to 
the  incisors  with  hooks  extending  over  the  centrals  to  prevent 
•he  bar  from  slipping  upward.  Owing  to  the  diverging  screws, 
the  bars  may  be  made  with  long  slots  or  the  central  piece  may  be 


a  tube  with  loose  ends  (Fig.  289).  The  alveolar  process  should 
then  be  cut  away  and  force  applied.  As  the  teeth  move  backward 
the  ends  of  the  bar  lengthens.  When  all  is  completed,  the 
appliance  is  removed  and  a  wire  soldered  to  bands  which  have 
been  so  adjusted  to  molars  or  second  bicuspids  to  hold  all  in 
position. 

The  cuspids  on  the  lower  jaw  sometimes  erupt  forward,  caus- 
ing contraction  of  the  jaw  and  irregularities  of  the  incisors. 
From  the  dense  bone  in  that  locality,  this  is  one  of  the  most 
difficult  conditions  to  correct.  Proceeding  in  the  manner 
described  in  the  previous  case,  the  operation  becomes  at  once 
simple  and  easy  (Fig.  277). 


446 


IRREGULARITIES    OF    THE    TEETH. 


The  application  of  the  screw  for  moving  the  various  teeth 
in  or  out  into  the  dental  arch  by  a  surgical  process  is  illustrated 
in  Fig.  290. 

A  method  employed  to  obtain  space  in  the  dental  arch  and 
which  in  many  cases  is  admirably  adapted  for  the  purpose,  is 
illustrated  in  Fig.  291. 

The  lever  "is  an  inflexible  bar,  capable  of  being  moved  about 
a  fixed  point,  called  the  fulcrum."  The  resistance  is  the  object 
to  be  moved ;  the  fulcrum  is  the  fixed  point  of  support ;  the  power 
is  in  the  force  which  overcomes  the  resistance.  According  to 
the  relative  position  of  these  are  three  kinds  of  levers  :* 

I.     Lever  of  the   first   kind:   Power — Fulcrum — Resistance. 


Fig.  ■30•^. 

2.  Lever    of    the    second    kind :    Power — Resistance — Ful- 

crum. 

3.  Lever  of  the  third  kind:  Resistance — Power — Fulcrum. 
An  example  of  the  first  kind  is  the  crow^-bar;  of  the  second, 

the  w^heelbarrow ;  of  the  third,  the  forceps. 

Intensity  of  force  is  gained  and  time  is  lost  in  proportion  as 
the  distance  between  the  power  and  the  fulcrum  exceeds  the  dis- 
tance between  the  resistance  and  the  fulcrum. 

In  using  the  lever  for  the  correction  of  irregularities  it  under- 
goes modifications.  Thus,  when  it  is  applied  in  the  form  of  a 
lig-ature  or  an  elastic  band,  it  becomes  flexible  instead  of  rigid, 
the  fulcrum  frequently  becomes  a  surface  instead  of  a  mere  point 
and  the  power  is  changed  into  resistance. 

*  These  can  be  remembered  by  the  formula,  i  2  3.  F  R  P.  In  the  first, 
the  fulcrum  is  in  the  middle,  the  second  resistance,  the  third  power. 


SURGICAL    CORRECTIONS. 


447 


Where  the  leverage  can  be  multipHed  most  stubborn  cases 
succumb,  as  is  ilhistratcd  in  rotating  teeth  set  very  firmly  in  the 
jaw,  or  those  crowded  closely,  or  teeth  of  persons  in  advanced 
years,  where  the  alveolar  process  has  become  very  dense  and 


Fig.  303. 


hard.  The  increase  of  power  in  the  lever  is  obtained  by  length- 
ening the  rod  proportionately  or  in  combining  the  leverage  with 
another  fqrce. 

The  application  of  an  increased  length  of  rod  is  limited,  for 


Fig.  304. 

want  of  space  in  the  mouth;  for  in  above  rather  limited  dimen- 
sions it  interferes  with  the  tongue  or  lips.  The  lever  is  required 
in  wherever  the  anterior  superior  teeth  occlude  inside  of  the 
inferior  teeth,  if  the  case  appear  early  enough.  It  is  always 
desirable  to  regulate  these  teeth  as  soon  after  their  eruption  as 


448 


IRREGULARITIES    OF    THE    TEETH. 


possible,  i.  e.,  before  the  bony  tissue  becomes  dense  and  hard 
(Fig.  292). 

This  is  a  lever  of  the  first  kind.  The  upper  incisor  that  strikes 
inside  is  the  resistance  to  be  moved,  the  lower  incisor  against 
which  the  stick  rests  is  the  fulcrum  and  the  hand  holding  the 
stick  is  the  power.    The  greater  the  distance  between  the  hand 


Fig.  305.  Fig.  306. 

and  the  resting  place  of  the  stick,  the  greater  the  force  exerted. 
When  such  cases  are  to  be  treated,  the  patient  comes  to  the 
office  at  9  A.  M.,  and  sits  in  front  of  the  operating  chair  where 
the  operator  can  watch  what  is  going  on.  A  long,  flat  file  handle 
or  similar  instrument  is  placed  in  the  mouth,  as  illustrated.  The 
patient  holds  the  instrument  firmly  against  the  teeth.  A  day  and 
sometimes  half  a  day  is  suf^cient  to  bring  the  tooth  outside  of 


Fig.  30r.  Fig.  308. 

the  lower  teeth.  As  soon  as  the  upper  tooth  strikes  outside  the 
lower  the  operation  is  completed  on  the  principle  of  the  wedge. 
Every  time  the  patient  closes  the  teeth  with  any  degree  of  force, 
the  wedge  (the  lower  incisors)  is  driven  a  little  farther  under  the 
upper,  thus  forcing  it  outward  until  even  with  the  rest.  This 
appliance  is  of  little  use  after  the  patient  has  arrived  at  the  age 
of  twelve  or  fourteen.     The  lever  is  more  successfully  used  in 


SURGICAL    CORRECTIONS. 


449 


connection  with  bands  and  tubes  for  rotating  teeth  as  observed 
under  the  heading,  "The  Pulley,  Wheel  and  Axle." 

The  simplest  form  of  leverage  is  a  wedge  of  cotton,  gutta 
percha  or  wood.    The  yielding  tooth  becomes  the  resistance,  the 


Fig.  309. 

resisting  tooth  the  fulcrum,  and  the  elasticity  of  the  intervening 
wedge  the  power.  When  cotton  or  wood  are  used  capillary 
attraction  becomes  the  source  of  power,  inasmuch  as  it  results 
in  the  absorption  of  moisture. 


Fisr.  310. 


Leverage  depends  for  its  efficiency  on  the  point  where  it  is 
applied.  Judgment  and  thought  exercised  in  this  will  amply 
repay  in  the  time  gained  and  pain  saved.  In  case  the  tooth  is  to 
be  brought  in,  it  is  a  matter  of  some  consequence  whether  force 
is  applied  half-way  betwen  the  cutting-edge  and  the  neck  or  at 

30 


450 


IRREGULARITIES    OF    THE    TEETH. 


the  cutting-edge.  The  apex  of  the  root  always  being  the  ful- 
crum, the  farther  from  this  it  can  be  applied,  the  better;  hence, 
it  is  desirable  to  apply  it  as  near  as  possible  to  the  cutting-edge. 
A  tooth  with  a  long  root  furnishes  the  advantage  of  distance 
from  the  fulcrum,  which  is,  however,  more  than  counterbalanced 
by  the  additional  resistance  thus  offered,  as  it  is  easier  to  move 
a  tooth  with  a  short  root. 


Fig.  311. 

The  pulley  is  a  wheel  with  a  groove  cut  into  its  circumference, 
and  is  movable  upon  its  axis.  In  mechanics  the  common  term 
for  pulley  is  sheave.  The  pulley  or  sheave  is  placed  between  the 
oblong  blocks  of  wood  through  which  the  axis  passes  and  sup- 
ports the  pulley  in  the  center.  The  cord  passing  around  the 
pulley  is  called  the  tackle.  The  bucket  and  weight  in  the  old- 
fashioned  well  illustrate  the  pulley.  The  wheel  and  axle  is  a 
modification  of  the  pulley.  The  wheel  is  fastened  securely  to  the 
A  A 


Fig.  :iVi. 


Fig.  313. 


axle ;  the  weight  is  attached  by  a  rope  to  the  axle,  and  the  power 
by  a  rope  to  the  wheel,  or  to  handles  fixed  at  right  angles  to 
its  rim.  The  steering-gear  of  a  vessel  is  an  illustration  of  this 
kind  of  lever.  The  wheel,  axle  and  pulley  are  modifications  of 
the  lever  of  the  first  kind,  the  circumference  of  the  wheel  or 
pulley  corresponding  to  the  long  arm ;  the  axle  or  block  to  the 
short  arm,  the  axis  in  both  cases  the  fulcrum.  The  general 
law  corresponds  to  that  of  the  lever.  Intensity  of  force  is  gained 
and  time  is  lost  in  proportion  as  the  circumference  of  the  wheel 


SURGICAL    CORRECTIONS. 


451 


exceeds  that  of  the  axle.  The  advantage  of  the  wheel  and  axle 
over  the  simple  lever  is  the  change  of  direction  of  power  which 
it  affords.  The  power,  instead  of  being  in  the  same  straight 
line  with  the  fulcrum  and  weight,  may  be  applied  at  an  angle. 
This  is  convenient  in  producing  the  rotation  of  a  tooth. 

In  its  application  to  regulating,  the  elasticity  of  the  rubber 
band  is  the  power;  the  tooth  or  teeth  over  which  it  passes  is 
the  fulcrum  and  the  tooth  to  be  moved  the  weight. 

Fig.  293  illustrates  the  rotation  of  a  tooth  by  having  a  gold 
band  with  an  arm  fitted  to  the  tooth  and  a  rubber  band  attached 
to  the  arm  and  stretched  to  the  first  bicuspid;  as  the  tooth 
rotates,  the  arm  is  bent  at  right  angles  to  the  band.    This  appli- 


Fi>.  314. 


cation  of  the  wheel  and  axle  will  accomplish  the  rotation  of  the 
teeth  in  the  majority  of  cases. 

It  should  be  observed  that  the  powder  of  an  elastic  band  is 
increased  wdth  the  tension  until  this  becomes  greater  than  the 
strength  of  the  material,  w^hen  it  will  break.  Hence,  the  greater 
the  number  of  teeth  over  which  it  passes,  the  greater  the  power 
of  the  band ;  but  at  the  same  time  it  is  lessened  by  the  friction 
of  the  surfaces  over  which  it  passes. 

The  inclined  plane — a  plane  surface  incHned  to  the  horizon 
at  any  angle— is  used  for  raising  weights.  The  longer  the 
inclined  plane,  the  easier  it  is  to  raise  a  body  a  given  height. 
When  the  power  acts  parallel  to  the  inclined  plane,  intensity  of 
force  is  gained  and  time  is  lost  in  proportion  as  the  length  of 
the  plane  exceeds  its  height. 

In  dentistry  this  force  has  been  found  as  of  peculiar  value 


452 


IRREGULARITIES    OF    THE    TEETH. 


in  cases  where  the  arch  is  to  be  widened  by  an  appliance ;  under 
such  circumstances  the  teeth  exert  an  outward  pressure  on  the 
opposite  jaw  and  the  articulation  of  the  cusps  makes  an  inclined 
plane. 

If  the  anterior  superior  teeth  close  inside  of  the  inferior  teeth 
they  should  be  brought  out  with  the  lever,  and  if  the  inferior 
teeth  be  too  short  to  exert  a  pressure  on  their  opponents,  they 
may  be  fitted  with  a  platinum  cap  and  cemented  securely  with 
zinc  oxyphosphate.  This  arrangement  maintains  a  constant  out- 
ward pressure  upon  the  superior  teeth  (Fig.  294).  In  the  illus- 
tration a  metal  plate  is  fastened  to  the  teeth  by  a  ligature  instead 
of  an  elastic  band.  Although  I  have  had  good  results  with 
this  method,  I  do  not  consider  it  of  anv  great  value,  for  the 


Fig.  315. 

reason  that  as  soon  as  the  teeth  begin  to  get  sore  to  touch,  pres- 
sure is  unconsciously  removed  by  the  patient  and  the  method 
proves  in  most  cases  -to  be  a  failure. 

The  wedge  is  a  modification  of  the  inclined  plane.  The 
power  is  applied  with  a  hammer  or  a  sledge  to  the  back  of  the 
wedge.  It  is  employed  in  various  ways  in  ordinary  mechanics, 
as  in  raising  buildings,  splitting  wood,  etc.  It  is  an  unsatisfac- 
tory force  to  calculate  upon,  because  the  large,  f^at  surfaces  pro- 
duce so  much  friction.  On  the  other  hand,  its  friction  is  useful 
in  retaining  the  wedge  in  its  position.  The  power  (acting  paral- 
lel to  the  base  instead  of  the  inclined  surface)  counterbalances 
a  weight  as  many  times  greater  than  itself  as  the  height  of  the 
wedge  is  contained  in  the  base.    When  applied  to  the  teeth,  the 


SURGICAL    CORRECTIONS. 


453 


wedge  increases  the  diameter  of  the  arc  of  a  circle  in  which 
the  teeth  are  implanted.  It  is  usually  made  of  fine-grained  wood 
or  India-rubber.  It  is  a  direct,  positive,  very  elTective  force. 
Teeth  with  long  roots,  deep  in  the  alveolar  process,  when  the 
latter  is  dense  and  hard,  are  difficult  to  start  with  ordinary  appli- 


Fig.  3:tJ. 

ances.  In  such  cases  the  wedge  is  of  great  service.  It  will 
readily  move  one  or  two  teeth  and  not  infrequently  three  will 
be  influenced  by  its  pressure.  Wedges  made  from  orange  wood 
are  very  serviceable,  as  they  can  be  readily  reduced  in  size  as 
the  case  may  require.  When  applied  to  the  teeth  they  become 
saturated  with  saliva,  swell,  and  in  so  doing  force  the  teeth 
apart.     When  a  rubber  wedge  is  used  one  slightly  larger  than 


Fig.  317 


the  space  between  the  teeth  is  selected  and  by  its  elasticity  the 
teeth  are  spread.  The  rubber  wedge  performs  its  work  with 
greater  rapidity,  perhaps,  but  it  causes  more  pain  than  the 
wooden  wedge.  Owing  to  elasticity  of  rubber  the  teeth  vibrate 
with  each  efifort  of  mastication,  whereas  they  are  held  firmly  by 
the  wooden  wedge. 


454 


IRREGULARITIES    OF    THE    TEETH. 


Each  of  the  six  mechanical  forces  has  its  proper  place  in  the 
art  of  regulating  teeth  and  when  skillfully  applied  each  is  an 
effective  agent.  The  application  of  these  forces,  however,  is 
limited.  Elasticity,  as  found  in  the  spring  of  metals  and  India- 
rubber,  combines  much  that  is  necessary  to  render  effective 
either  the  most  rudimentary  deficient  or  the  most  intricate  appli- 
ance. The  simplicity  of  the  application  of  this  force  makes  it 
peculiarly  suitable  to  dentistry. 

Next  to  the  screw,  elasticity  of  metals  gives  more  satisfac- 
tion in  correcting  deformities  than  any  other  appliance.  Although 
it  is  not  a  positive  force,  yet  it  has  the  advantage  of  being  readily 
held  under  control. 


Fig.  318. 

Metal  molecules  are  held  together  by  cohesion.  These  parti- 
cles change  in  their  relative  positions  when  the  metal  is  acted 
upon  by  an  external  force.  If  this  force  be  removed  before 
these  changes  exceed  a  certain  limit,  the  particles  return  to. their 
previous  positions.  This  power  of  returning  to  original  form 
is  called  elasticity.  This  elasticity  of  metals  may  be  utilized  in 
regulating  teeth  with  results  only  limited  by  the  amount  of 
spring  which  a  metal  possesses.  There  are  many  degrees  of 
elasticity.  A  metal  cannot  be  absolutely  elastic  ;  that  it  cannot  go 
back  exactly  to  its  previous  form.  Every  body  is  elastic  in  a 
degree.  Gold  belongs  to  the  inelastics,  alloyed  with  other  met- 
als (platinum)  it  becomes  a  markedly  elastic  metal. 

German  silver  and  piano  wire  are  my  favorite  metals.  A 
little  appliance,  which  I  have  used  for  thirty  years,  has  given  as 


SURGICAL    CORRECTIONS. 


455 


much  satisfaction  in  correcting  irregularities  of  the  teeth  as  the 
screw.  Take  commercial  German  silver  plate  and  roll  it  to  Nos. 
29,  31  and  32,  U.  S.  gauge.  These  thicknesses  are  required  to 
obtain  different  strengths  of  metal.  Cut  into  strips,  take  the 
thinnest  strip,  place  flat  nose  pliers  in  the  center  (Fig.  295),  and 
bend  the  strip  the  width  of  the  tooth  to  be  brought  into  line. 
Then  with  round  nose  pliers  bend  the  ends  in  the  opposite 
direction,  just  a  little  shorter  than  the  adjoining  teeth,  cut  and 
trim  the  corners  and  edges  so  that  the  lips  and  cheeks  may  not 
be  injured ;  this  is  to  be  crowded  into  place.  This  afifords  double 
leverage,  inasmuch  as  it  draws  one  tooth  in  and  the  other  out 
(Fig.  296).     d  is  the  weight,  the  proximal  surfaces  of  the  two 


Fig.  .319. 

adjoining  teeth  at  c  are  the  fulcrum  and  a  the  power,  or  a  the 
resistance,  c  the  fulcrum  and  d  the  power.  The  strongest  tooth 
affords,  of  course,  the  greatest  resistance. 

The  power  in  cases  like  this  depends  largely  on  the  elasticity 
and  tenacity  of  the  metal.  If  the  intervening  medium  between 
the  proximal  surfaces  of  the  resisting  tooth  and  that  of  the  tooth 
to  be  moved  have  little  or  no  elasticity,  the  intervening  medium 
will  yield  readily,  and    nothing  can  be  accomplished. 

Rolling  the  German  silver  into  fixed  thicknesses  gives  the 
metal  its  elasticity,  hence  it  must  not  be  heated  after  it  is  run 
through  the  mill.  Fig.  297  shows  some  of  the  positions  in 
which  this  metal  may  be  used.  All  teeth,  however,  anterior  to 
the  first  permanent  molars  may  be  brought  froin  either  direction 


456  IRREGULARITIES    OF    THE    TEETH. 

into  line  by  this  process.  The  surgical  procedure  is  Hkewise 
here  ilhistrated.  The  superior  incisors  situated  just  inside  the 
lower  may  be  brought  into  line  without  the  use  of  a  plate  to  keep 
the  jaws  apart.  This  appliance  must  be  removed  every  day  and 
with  round  nose  pliers  the  ends  are  bent,  the  spring  shortened 
and  forced  into  place  upon  the  tooth,  so  easily  that  caution  must 
be  observed  not  to  exceed  the  intended  results. 

Piano  wire  manufactured  in  Germany,  England  and  America 
is  made  of  the  best  steel,  drawn  through  a  draw-plate  to  the 
required  size ;  polish  and  temper  are  given  during  this  process. 
The  wire  must  be  extremely  pliable  and  strong  to  endure  the 
tension  which  it  undergoes  during  the  tuning  process  of  a  piano. 
It  must  also  be  perfect  in  construction,  since  a  flaw  in  the  wire 
makes  it  to  snap  when  being  manipulated.     It  has  great  advan- 


Fii,'    3^0  Fig.  .3-,'l. 


tages  for  dental  purposes.  It  is  inexpensive,  has  greater  elas- 
ticity than  other  wires  and  can  be  more  easily  adapted  to  a 
variety  of  cases.  It  can  be  bent  in  any  way  necessary  to  obtain 
the  greatest  amount  of  force  and  can  be  applied  to  any  place 
in  the  mouth,  on  account  of  its  small  size  and  weight.  Sizes 
i8,  19,  20  are  better  suited  to  the  majority  of  irregularities,  the 
strength  of  the  wire  to  perform  a  given  operation  depending 
upon  the  age  and  constitution  of  the  individual  and  the  character 
of  the  irregularity.  In -youth  or  in  delicate  organizations.  No. 
20  is  the  size  best  adapted  to  regulate ;  the  sizes  should  decrease 
to  No.  17  as  the  years  advance,  or  as  the  stubbornness  of  the 
irregularity  demands.  The  selection  of  the  wire  and  adaptation 
to  each  special  case  so  as  to  secure  the  best  results  and  avoid 
inflammation  requires  nice  discrimination. 

In  order  to  obtain  the  best  results,  the  elasticity  of  the  wire 


SURGICAL    CORRECTIONS.  457 

was  increased  by  coiling  it  from  one  to  three  times  around  a 
mandril.  The  idea  of  the  coil  in  connection-  with  piano-wire 
occurred  to  me  at  the  1881  International  Medical  Congress. 
These  coil  springs  have  been  placed  at  the  dental  depots  for 
the  benefit  of  those  who  have  not  the  time  to  make  their  own 
springs.  The  mandril  is  driven  into  the  bench  and  with  the 
right  hand  the  wire  is  coiled  about  it  as  many  times  as  required, 
the  short  end  being  held  firmly  by  the  left  hand.  The  coil  ends 
directly  at  the  starting  point  and  gives  thereby  the  greatest 
elasticity  and  length  of  arms.  When  necessary,  the  long  end 
of  the  wire  can  be  bent  with  square-nose  pliers  to  make  it  on 
the  same  plane  with  the  other  arm.  Fig.  298  shows  the  coil 
spring. 

The  coil  of  the  spring  works  on  the  same  principle  as  the 
mainspring  of  an  American  watch,  which,  between  two  points, 
measures   a   uniform  period   of   time.     The   extremities   of  the 


Fig.  :m. 

arms  of  the  spring  travel  over  a  given  space  with  like  uniformity, 
which  gives  a  mild  uniform  pressure  to  the  jaws  and  teeth.  The 
arms  may  be  bent  in  any 'position  and  cut  at  any  length  to  suit 
the  case  in  hand.  One  or  more  coils  may  be  used  on  the  same 
wire.  They  may  be  used  in  connection  with  a  rubber  plate,  or 
with  bands  of  gold  or  platinum  fastened  to  the  teeth  with  zinc 
oxyphosphate.  With  holes  properly  drilled  in  the  plate  or  bands 
and  the  arms  fitted  into  them,  the  spring  will  stay  in  position. 
When  the  spring  is  used  without  a  plate,  it  will  be  well  to  fasten 
the  wire  in  some  of  the  teeth  to  prevent  its  being  swallowed, 
should  it  accidentally  spring  out  of  place. 

The  following  histories  illustrate  some  difficulties  in  prac- 
tice : 

The  following  models  of  the  mouth  of  a  sixteen-year-old 
girl,  a  patient  of  Dr.  J.  F.  Austin,  of  Chicago,  show  a  deformity 
I  corrected.  The  right  cuspid  had  encroached  upon  the  lateral 
incisor  to  such  an  extent  as  to  twist  and  force  it  out  of  position, 


458 


IRREGULARITIES    OF    THE    TEETH. 


leaving  only  about  one-half  of  the  space  necessary  to  rotate 
the  tooth  into  place.  A  plate  was  made  to  fit  the  mouth  and 
teeth  and  a  coil-spring  inserted,  with  arms  meeting  the  cuspid 
and  central  incisor.  The  spring  was  secured  to  the  plate  by  a 
pin  driven  into  the  plate  (Fig.  299).  By  the  lateral  pressure 
of  the  spring  the  teeth  were  pushed  apart,  making  space  for 
the  teeth  to  be  rotated  into  place.  Fig.  300  shows  the  tooth 
secured  in  position  by  the  Magill  retainer. 

On  an  exact  plaster  model  of  the  case  to  be  regulated  a  thin, 
narrow  vulcanite  plate  is  formed,  with  a  short,  vertical  post  fixed, 
either  before  vulcanizing  or  afterward,  by  drilling  centrally  in 


Fig.  3^4. 


the  plate  on  the  median  line.  Grooves  or  slots" are,  with  a  wheel 
bur,  cut  in  the  sides  of  the  plate  to  receive  the  ends  of  the  spring 
and  prevent  its  displacement  after  the  coil  has  been  placed  on  the 
post.  Fig.  301  represents  such  an  appliance  in  position  on  a 
plaster  cast  of  the  inferior  maxilla  of  a  boy  aged  twelve  years 
and  it  will  thus  be  seen  that  the  movements  of  the  tongue  would 
not  be,  as  in  practice  they  were  not,  seriously  restricted.  The 
tension  of  the  spring  is  changed  by  simply  bending  outward  or 
inward  its  arms.  In  many  cases  the  apparatus  may  be  inserted 
or  removed  with  great  facility  and  its  action  so  continued  and 
controlled  that  required  expansion  is  obtained  and  maintained 


SURGICAL    CORRECTIONS. 


4".n 


by   merely  one   plate.     This   plate,  with   spring  attached,  was 
removed  by  the  boy  twice  a  day  and  the  teeth  and  plate  cleaned. 
In  spreading  the  dental  arch  the  majority  of  cases  require 
the  greatest  pressure  on  the  anterior  teeth  and  an  appliance  that 
can  be  placed  inside  the  arch  will  exert  the  greatest  influence. 
The  force  is  equally  distributed  on  both  sides  of  the  mouth  and 
if  constant  the  work  will  be  accomplished  rapidly,  without  incon- 
venience to  the  patient.     Such  an  appliance  is  here  illustrated 
(Fig.  302).     It  was  used  in  the  mouth  of  a  young  girl  fourteen 
years  of  age.    A  plate  made  to  fit  the  teeth  and  alveolar  process 
was   cut   away   so   that  the   anterior   parts  extend  far  enough 
forward  to  inclose  the  teeth  to  be  moved.     A  piece  of  wire  was 
bent  to  either  of  the  forms  shown  in  Fig.  303,  wherein  a  is  the 


Fig.  325. 

coil  and  fixed  point  and  b  b  movable  arms  extending  from  a 
and  also  fixed  points,  cc,  movable  arms  extending  from  b  b. 

Grooves  were  cut  into  the  anterior  and  posterior  parts  of 
the  plate  to  correspond  with  and  receive  the  points  b  b  and  c 
c     Holes  were  drilled  at  these  points  and  the  wires  tied  to  the 
rubber  plates.     In  order  that  the  anterior  teeth  may  be  moved 
with  the  greatest  force,  the  arms  are  so  adjusted  that  the  greatest 
pressure  is  exerted  on  the  anterior  parts  of  the  plates.     This 
appliance  is  readily  removed  for  cleansing  and  returned  to  place 
by  the  patient.     A  coil  spring,  however,   with  two  pomts  of 
attachment  is  not  as  efficient  at  the  second  as  at  tlie  first  pomt. 
Another  appliance  for  widening  the  dental  arch  that  has  been 
successfully  used  is  illustrated  in  Fig.  304-  It  consists  of  a  rubber 
plate  made  to  fit  the  teeth  and  jaw.  The  plate  is  then  sawed  length- 
wise-commencing at  a  point  anterior  to  the  teeth  to  be  moved; 
a  hole  is  drilled  at  the  point  where  the  slot  stops  to  prevent  the 


460  IRREGULARITIES    OF    THE    TEETH. 

arms  breaking.  At  the  extreme  end  holes  are  drilled  to  receive 
the  spring.  To  adjust  the  plate  press  the  arms  together  and 
drop  the  plate  into  place.  Fig.  305  shows  the  plate  out  of  the 
mouth.     This  can  be  removed  and  inserted  by  the  patient. 

A  form  of  dental  irregularity  difficult  to  correct  occurs  when 
the  cuspids  are  situated  near  or  in  contact  with  the  centrals, 
while  the  laterals  stand  inside  of  the  arch,  and,  when  the  jaws 
are  closed  pass  behind  the  central  incisors.  If  these  laterals 
be  in  near  relations,  ordinary  means  do  not  interact  upon  them 
with  sufficient  pressure  to  force  them  apart ;  the  space  being 
quite  too  short  to  admit  a  jack-screw. 

Fig.  306  represents  such  a  condition.  The  cut  is  made  from 
the  cast  of  an  eighteen-year-old  woman,  who  came  under  care 
in  1883.  The  superior  laterals  were  then  only  one-fourth  of  an 
inch  apart  and  closed  behind  the  inferior  incisors.  There  were 
but  small  spaces  between  the  superior  centrals  and  cuspids. 

Thin  platinum  collars  were  made  to  fit  the  laterals,  on  which 
after  driling  a  hole  in  the  side  of  each  collar,  they  were  firmly 
fixed  with  zinc  oxyphosphate.  A  spring  was  bent  into  the  form 
shown  in  Fig.  307,  the  ends  of  the  arms  being  turned  at  a  sharp 
angle  and  cut  short  as  seen  in  the  figure. 

The  spring  was  then  put  in  place,  the  arm  ends  entering  the 
holes  in  the  collars  and  the  curved  arms  were  closely  conformed 
to  the  surface  of  the  gums  and  palatine  parts  so  that  the  fixture, 
while  no  obstruction  to  occlusion,  could  be  easily  sprung  out 
of  position  for  cleansing  purposes  or  for  increasing  the  expansive 
power  of  the  spring,  by  simply  widening  the  lateral  spread  of 
the  arms.  Fig.  306  shows  the  progress  made  in  four  weeks' 
treatment.  When  the  laterals  had  been  moved  past  the  sides 
of  the  centrals,  they  were  by  other  means  forced  outward  into 
line. 

To  force  out  central  and  lateral  incisors,  I  have  found  the 
following  methods  useful :  Around  the  tooth  to  be  moved  and 
around  the  molars,  as  nearly  opposite  the  direction  the  incisor 
is  to  travel  as  possible,  fit  platinum  collars.  Solder  cups  upon 
the  collars  directly  opposite  and  in  line.  Make  a  spring  of  piano- 
wire  (Fig.  308)  and  spring  it  into  the  cups  soldered  upon  the 
collars.     In  Fig.  309  the  appliance  is  seen  in  place. 


SURGICAL    CORRECTIONS. 


461 


Another  method  is  to  make  a  plate  to  fit  the  teeth,  thick- 
ening it  nearly  to  the  cutting  edge  of  the  tooth  to  be  moved,  and 
drilling  a  hole  through  the  thickened  part.  Directly  opposite, 
at  some  convenient  point  on  the  back  part  of  the  plate,  drill 
another  hole  just  deep  enough  to  hold  the  spring  in  place  (Fig. 
310).  If  the  hole  in  the  thickened  part  be  drilled  in  the  proper 
place,  the  end  of  the  spring  will  hit  the  tooth  midway  between 
its  cutting-edge  and  the  margin  of  the  gum.  The  spring  is 
very  effective.  The  pressure  is  constant  and  the  spring  is  readily 
removed  for  adjustment  or  for  any  other  purpose. 

A  single  tooth  is  often  so  situated  inside  the  dental  arch 


FiK.  :m. 

that  there  is  trouble  in  contriving  an  apparatus  suited  to  its  cor- 
rection. 

The  illustrations  represent  some  simple  appliances  that  have 
been  thoroughly  tested  and  found  satisfactory ;  they  do  the  work 
effectively,  are  easy  of  adjustment  and  removal  and  they  may 
be  readily  cleansed. 

Fig.  311  illustrates  a  second  inferior  bicuspid  of  the  right 
side,  having  a  lingual  presentation  equal  to  one-half  the  thickness 
of  the  tooth  inside  of  its  normal  position.  The  cut  also  shows 
teeth  in  other  malpositions. 

For  this  case  a  thin,  narrow,  close-fitting  vulcanite  plate  was 
made,  and  a  hole  was  drilled  through  the  middle  of  the  plate 
opposite  the  center  of  the  tooth  to  be  moved.  In  the  other  side 
another  hole  was  drilled,  but  not  quite  through  the  plate.  A 
suitable  spring  (Fig.  312)  was  then  made  of  piano-wire,  having 
a  single  coil,  A,  and  the  ends  of  its  arms  bent  at  about  a  right 


462  IRREGULARITIES    OF    THE    TEETH. 

angle.  One  of  these  ends,  C,  was  cut  short  to  enter  the  corre- 
sponding hole  in  the  plate,  and  the  other  end,  B,  left  long  enough 
to  go  through  the  plate  and  impinge  on  the  lingual  surface  of 
the  bicuspid,  leaving  a  full  eighth  of  an  inch  between  that  arm 
of  the  spring  and  the  plate,  as  is  clearly  shown  by  Fig.  311.  Fig. 
313  shows  both  arms,  B  B,  of  the  same  length,  to  pass  through 
the  plate  and  impinge  on  lingual  surfaces  of  teeth  upon  opposite 
sides. 

Fig.  314  shows  an  appliance  for  pulling  out  the  central  incis- 
ors. A  plate  is  made  to  fit  the  jaw  and  teeth  and  into  it  were 
vulcanized  two  of  the  Talbot  springs  at  the  lateral  incisor  region. 
The  wire  arms  were  turned  into  loops  at  the  extremities  to 
secure  a  ligature.  When  the  plate  was  adjusted,  the  arms  were 
bent  horizontally  and  brought  in  close  proximity  to  the  labial 
surfaces  of  the  central  incisors  and  securely  tied.  By  this  means 
constant  pressure  was  applied  and  the  teeth  were  carried  outside 
of  the  inferior  incisors.  Moving  individual  teeth  in  or  out  into 
line  or  rotating  them  in  their  sockets  by  the  use  of  piano-wire 
is  illustrated  in  Fig.  315  and  Fig.  316.  The  surgical  procedure 
is  likewise  demonstrated. 

I  have  succeeded  in  erupting  teeth  by  the  following  method : 
Fig.  317  illustrates  the  right  superior  lateral  arch  of  an  eighteen- 
year-old  boy.  At  about  the  tenth  year  I  was  able  to  indicate 
in  outline  the  crown  and  root  of  the  cuspid  and  noticed  the 
marked  obliquity  of  its  position.  The  posterior  column  was 
crowding  the  bicuspids  forward  so  that  they  eventually  filled 
the  space  allotted  to  the  cuspid.  The  teeth  in  the  left  superior 
lateral  arch  came  into  position  in  the  natural  order,  and  that 
arch  was  nearly  normal.  I  waited  until  the  point  of  the  cuspid 
made  its  appearance,  extracted  the  first  bicuspid.  Platinum 
bands  were  fitted  to  the  second  bicuspid  and  lateral  incisor  and 
these  were  connected  with  a  bar  of  platinum  extending  to  and 
impinging  upon  the  central  incisor.  A  flat  tube  was  then  sol- 
dered to  the  bar  for  the  purpose  of  securing  a  coiled  spring, 
made  of  the  smallest  size  piano-wire,  the  arms  being  cut  to 
about  the  same  length.  One  arm  was  doubled  upon  itself  and 
so  adjusted  that  when  it  was  passed  into  the  flat  tube  the  suitably 
bent  end  of  the  other  arm  would  reach  forward  and  catch  upon 


SURGICAL    CORRECTIONS. 


403 


the  poinj;  of  the  cuspid.  The  alveolar  process  was  then  cut 
away,  care  being-  taken  not  to  injure  the  outer  plate  and  peri- 
osteum. By  this  means  the  cuspid  was  swung  backward  and 
pulled  downward  until  the  crown  was  in  direct  line  with  the 
position  it  was  to  occupy  when  in  place.  An  impression  was 
then  taken  and  a  vulcanite  plate  made  (Fig.  318),  in  which 
another  spring  of  piano-wire  was  inserted  in  such  a  manner  that 
when  properly  adjusted  the  end  of  the  arm  reached  over  and 
just  inside  of  the  space  of  the  cuspid.  A  ligature  was  then 
tied  around  the  neck  of  the  tooth  and  the  arm  of  the  spring 
drawn  close  to  the  crown  and  fastened.  By  glancing  at  Fig. 
318  it  will  be  observed  that  the  action  of  the  spring  must  be 
to  draw  the  tooth  not  only  down,  but  also  inward  to  its  position. 
In  locating  the  spring  in  the  plate,  the  position  of  the  crown 


<   ] 


^}n-u 


Fig.  327. 

before  and  after  it  is  brought  into  place  must  not  be  lost  sight 
of.  When  the  spring  is  applied  for  the  purpose  of  drawing  the 
tooth  out  of  the  alveolar  process,  the  patient  must  be  seen  every 
day,  because  in  most  cases  this  movement  is  so  easily  accom- 
plished that  only  twenty-four  hours  are  necessary  to  complete 
the  operation.  If,  on  the  other  hand,  two  or  more  days  super- 
vene before  the  patient  is  seen,  the  tooth  would  be  erupted 
further  than  is  required. 

Teeth  wholly  imbedded  in  the  jaw  may  be  erupted  with  a 
spring,  as  shown  in  Fig.  319,  by  first  removing  a  piece  of  mucous 
membrane  and  "alveolar  process  over  the  crown  with  Rollins' 
revolving  knife.  The  advantages  of  this  peculiar  kind  of  spring 
in  these  difficult  cases  are:  ist,  it  can  be  adjusted  to  any  special 
angle  required,  and,  2nd,  the  force  is  constant  and  need  not  be 
readjusted  for  three  or  four  days  after  it  is  applied  (if  the  move- 


464  IRREGULARITIES    OF    THE    TEETH. 

ment  be  not  rapid),  thus  relieving  the  operator  and  patient  from 
the  expenditure  of  time  in  frequent  office  attendance. 

A  form  of  irregularity  of  the  teeth  is  occasionally  observed 
wherein  the  cuspids  erupt  inside  of  the  arch.  Sometimes  the 
case  presents,  when  the  point  of  the  cusp  has  just  penetrated 
the  mucous  membrane  of  the  mouth,  and  again  the  tooth  will 
have  erupted  its  normal  length.  Frequently  it  will  erupt  in  close 
contact  with  the  lateral  incisor  and  first  bicuspid,  or  it  may  make 
its  appearance  in  the  roof  of  the  mouth.  Occasionally  only 
one  cuspid  will  be  misplaced.  Again,  both  cuspids  will  thus 
erupt  out  of  position.  Fig.  319  illustrates  an  instance  of  this 
kind  occurring  in  the  mouth  of  a  sixteen-year-old  girl.  Both 
cuspids  were  in  process  of  eruption  inside  the  arches  and  in  con- 
tact with  the  adjoining  tooth.  The  roots  could  be  outhned  on 
the  outer  alveolar  plate  as  far  as  their  apices,  demonstrating  the 
fact  that  the  crypts  containing  the  crowns  were  originally  in 
normal  positions,  but  that  their  crowns  had  subsequently  pointed 
toward  the  roof  of  the  mouth.  A  vulcanite  plate  was  made  and 
a  hole  drilled  through  it  so  that  the  point  of  a  wire  spring  would 
touch  the  cuspid  just  above  the  margin  of  the  gum.  On  the 
opposite  side  of  the  plate  a  hole  was  drilled  just  deep  enough 
to  hold  the  other  end  of  the  spring  when  in  position.  A  cap 
was  cemented  and  a  small  hole  drilled  in  it  to  prevent  the  spring 
from  slipping  when  adjusted  in  position.  A  strong  spring  was 
made  of  piano-wire,  No.  17  or  18  U.  S.  gauge,  and  the  ends  bent 
at  right  angles.  One  of  the  ends  was  cut  short  to  fit  into  the 
hole  made  in  the  plate  opposite  the  tooth  to  be  moved,  the 
other  end  left  long  enough  to  pass  through  the  plate  and  sharp- 
pointed  to  enter  a  hole  in  the  band  of  the  tooth  to  be  moved. 
The  alveolar  process  was  then  cut  away  in  the  direction  of  the 
moving  tooth.  In  many  cases  such  a  spring  will  keep  the  plate 
in  position,  but  should  the  plate  slip  it  may  be  fastened  to  the 
bicuspid  with  ligatures. 

Fig.  320  illustrates  the  left  side  of  the  lower  denture  of  a 
thirteen-year-old  boy.  The  second  deciduous  molar  had  been 
retained  in  the  jaw  beyond  the  natural  period  and  its  mesial 
and  distal  surfaces  had  been  so  destroyed  by  caries  that  the 
first  permanent  molar  had  come  forward  and  greatly  diminished 


SURGICAL    CORRECTIONS. 


465 


its  normal  distance  from  tlic  first  bicuspid.  The  removal  of  the 
deciduous  molar  left  an  insufficient  space  for  the  accommodation 
of  the  coming  second  bicuspid,  which  consequently  had  become 
locked  between  the  molar  and  first  ])icuspid,  so  that  complete 
eruption  was  impossible. 

A  narrow  vulcanite  jilate  was  made  and  a  coiled  wire  si)rin^' 
was  so  applied  as  to  force  the  teeth  a])art.  When  sufficient 
room  had  been  g-ained,  a  cavity  was  formed  in  the  crown  of 
the  second  bicuspid  and  small  wire  eye-bolt  set  in  the  cavitv 
with  amalgam.  Another  coiled  wire  spring  was  fixed  in  the 
plate  and  the  spring  lever  inserted  in  the  eye  of  the  bolt,  as 
shown  in  Fig.  321.  The  lifting  action  of  the  spring  soon  com- 
pelled the  eruption  of  the  bicuspid  into  its  proper  position  and 
relations  with  the  occluding  teeth. 

The  removal  of  the  eye-bolt  after  cutting  away  the  amalgam 


Fig.  328. 

with  a  small  round  bur  and  the  subsequent  filling  of  the  small 
cavity  with  gold  completed  the  operation. 

Obviously  a  ligature  could  have  been  forced  down  upon  the 
submerged  crown  of  the  bicuspid  and  the  loop-hitch  of  the  liga- 
ture be  made  a  substitute  for  the  eye-bolt.  This  was  preferred  as 
a  more  positive  means  of  attachment  to  the  lifting  spring  lever. 

June,  1884,  the  following  treatment  was  begun  for  rotating 
the  central  incisor  of  a  patient.  A  platinum  band  was  made  to  fit 
the  tooth  and  a  tube  of  the  same  material  w^as  soldered  length- 
wise with  the  band  (Fig.  322).  The  band  was  secured  to  the 
tooth  with  zinc  oxyphosphate,  a  piece  of  piano-wire  being  passed 
into  the  tube  and  allowed  to  extend  to  the  left  central  incisor 
(Fig.  323).  The  wire  was  bent  every  day  and  the  tooth  thus 
rotated  into  place.  When  practicable  a  flat  tube  should  be  sol- 
dered to  the  band  for  the  purpose  of  holding  a  flat  lever,  which 

81 


466  IRREGULARITIES    OF    THETEETH. 

would  prevent  the  rotation  of  the  arms.  For  rotating  a  tooth  the 
most  efficient  contrivance  is  the  combined  lever  and  collar,  fitting 
and  fixed  upon  the  tooth  by  cement  (Fig.  324).  The  soldering 
of  a  flattened  tube  across  the  face  of  the  collar  affords  a  means 
for  the  insertion  and  removal  of  the  lever  at  will. 

I  prefer  a  lever  made  of  a  piece  of  thin  piano -wire,  No.  27, 
U.  S.  gauge,  one  end  of  which  is  folded  upon  itself  for  about  a 
quarter  of  an  inch  and  the  wire  then  coiled  once  or  twice  close 
to  the  folded  end  (see  illustration).  The  other  end  is  bent  to 
hook  around  a  molar  or  other  posterior  tooth.  The  illustration 
shows  such  a  tubed  collar  and  wire  lever  separately  and  also  in 
place  on  the  tooth  which  is  to  be  rotated.  It  is  obvious  that  the 
lever  can  be  removed  or  applied  without  detaching  the  cemented 
collar.  In  operation,  the  compound  lever  effects  a  complex 
movement  of  the  tooth,  which  is  being  rotated  by  the  lever  as  a 
whole  and  is  at  the  same  time  thrown  outward  by  the  hinge- 
like action  of  the  short  lever  turning  on  the  coil  as  on  an  axis — 
the  result  being  the  proper  alignment  of  the  tooth,  if  the  spring 
of  the  coil  and  the  elasticity  of  the  lever  be  judiciously  adapted 
to  the  case. 

The  other  central  incisor  can  Hkewise  be  simultaneously 
rotated,  and,  after  both  teeth  had  been  brought  into  position,  a 
folded  wire  bar  through  both  tubes  would  retain  them  in  place 
so  long  as  might  be  deemed  desirable. 

Elastic  bands  cut  from  French  rubber  tubing  are  applicable 
to  every  case  of  irregularity  of  the  teeth.  Elasticity  is  peculiarly 
adapted  to  the  correction  of  irregularities,  because  of  its  con- 
stant equable  pressure,  which  may  be  increased  or  diminished 
by  varying  the  size  of  the  bands.  This  constant  pressure  pro- 
(iuces  rapid  absorption  of  the  bone,  which  opposes  the  restora- 
tion of  the  tooth  to  its  normal  position. 

When  the  rubber  bands  are  applied  to  the  teeth,  the  point  of 
resistance  becomes  very  important.  The  resistance  must  equal 
or  exceed  that  of  the  body  to  be  moved;  otherwise,  the  weaker 
will  be  moved  by  the  stronger  force.  If  a  tooth  upon  one  side  be 
irregular,  a  tooth,  or  if  necessary,  several  teeth,  at  the  opposite 
point  must  be  selected  to  withstand  the  pressure  of  the  tooth 
to  be  moved.     This  requires  thorough  knowledge  of  the  anat- 


SURGICAL    CORRECTIONS.  4G7 

omy  of  the  teeth  and  jaws  and  ability  to  judge  comparative 
resistance  of  each  tooth. 

When  the  rubber  bands  are  employed  in  cases  requiring 
much  force,  it  is  generally  a  good  plan  to  fit  a  rubber  plate  to 
the  teeth  and  jaw,  to  which  arms  of  rubber  or  gold  are  attached 
in  such  a  manner  that  the  teeth  may  be  drawn  in  or  out,  as  the 
case  requires.  The  plate  should  be  fastened  by  ligatures  to  fix 
teeth,  and  acts  as  the  point  of  resistance.  Rubber  bands  cut 
from  tubing  (or  better,  from  rubber  dam,  as  suggested  by  Dr. 
G.  V.  Black)  are  attached  to  the  arms  and  carried  over  the  teeth 
to  be  moved.  Fig.  325  is  from  the  model  of  the  teeth  of  a  four- 
teen-year-old boy.  The  lower  jaw  occludes  outside  the  upper. 
A  piece  of  gold  wire  (Fig.  326)  was  bent  to  the  contour  of  the 
dental  arch,  allowing  a  space  of  3-16  of  an  inch  between  the 
teeth  and  the  wire  and  soldered  to  two  bands  attached  to  the 
second  bicuspids  (first  bicuspids  or  molars  may  be  used  if 
desired).     The  surgical  procedure  is  also  illustrated.     Rubber 


Fiij.  ;Wil.  Fig.  330. 

dam  rings  were  fastened  to  the  band  and  carried  over  the  incisors 
and  cuspids.  These  teeth  were  dried  and  cleansed  with  alcohol. 
Zinc  oxyphosphate  was  then  mixed  until  it  became  sticky,  when 
it  was  placed  upon  the  lingual  surfaces  of  the  teeth  for  the  pur- 
pose of  holding  the  bands.  Protruding  teeth  may  be  brought 
into  line  in  the  same  manner  by  reversing  the  wire,  placing  it 
upon  the  inside  of  the  mouth  and  proceeding  as  before.  The 
teeth  were  in  a  short  time  brought  out  into  place  by  the  attach- 
ment of  rubber  rings  to  the  gold  band  and  over  the  teeth.  The 
result  is  illustrated  in  Fig.  327. 

Teeth  may  be  rotated  in  their  sockets  with  rubber  bands  in 
the  following  manner:  Cut  away  the  alveolar  process.  Fit  a 
band  of  platinum  accurately  to  the  crown  and  solder.  Make 
a  hook  by  inserting  and  soldering  a  pin  from  an  artificial  tooth 
into  a  hole  drilled  in  the  labio-distal  angle  of  the  band.  Fasten 
this  band  upon  the  tooth  with  zinc  oxyphosphate.  Attach  a 
band  of  rubber  at  one  end  to  the  hook  and  at  the  other  to  a 
bicuspid,  the  tooth   being  thus  rotated  into  place.      Another 


468  IRREGULARITIES    OF    THE    TEETH. 

plan :  dry  the  tooth,  coat  it  with  sandarac  varnish  and  while 
moist  wind  about  it  a  strip,  cut  from  rubber  dam,  three-six- 
teenths of  an  inch  wide  and  two  inches  long,  with  a  string  tied 
in  its  middle,  so  that  the  rubber  dam  doubles  upon  itself.  Zinc 
oxyphosphate  may  be  used  upon  the  tooth  for  the  same  purpose. 
The  band  should  be  wound  in  the  same  direction  in  which  the 
tooth  is  to  be  rotated  and  the  winding  should  be  continued  until 
the  end  of  the  rubber  reaches  the  distal  edge  of  the  tooth ;  the 
string  should  now  be  drawn  across  the  mouth  and  tied  to  a 
molar  or  bicuspid  tooth.  This  has  not  been  as  successful  as  the 
use  of  the  Chinese  grass  line. 

Ligatures  are  cords,  strings,  or  wires  for  regulating  and  bind- 
ing the  teeth  for  the  attachment  of  other  appliances  to  the  teeth 
or  for  holding  them  securely  after  they  have  found  their  places. 
Silk,  linen  or  Chinese  grass  (raw  silk  fish  line)  ligatures  serve  a 
good  purpose.  When  ligatures  are  used  to  regulate,  they  act 
upon  the  teeth  to  be  moved  by  attaching  them  to  a  fixed  point 
and  also  by  the  shrinkage  of  the  fiber  when  moistened.  Care 
should  be  taken  in  tying  the  knot  of  a  ligature  to  avoid  its  work- 
ing up  under  the  gum.  \'arious  knots  can  be  made  for  this 
purpose.  Since  the  introduction  of  Dr.  Magih's  band  for  regu- 
lating teeth,  the  ligature  has  become  a  very  useful  adjunct  for 
fastening  appliances  at  any  point  upon  the  band  where  a  pin 
or  tube  has  been  previously  soldered.  The  raw  silk  fish  line  has 
been  found  far  superior  to  any  ligature  or  rubber  band,  since,  as 
it  contracts,  it  holds  the  tooth  steady,  therefore  prevents  soreness 
on  account  of  vibration. 

A  quicker  and  easier  method  of  holding  ligature  wire  or  rub- 
ber bands  to  teeth  to  prevent  their  slipping  is  to  wipe  the  tooth 
dry,  clean  it  thoroughly  with  95-per-cent  alcohol  and  mix  zinc 
oxyphosphate  into  a  sticky  paste,  apply  this  to  the  tooth  or 
teeth  and  allow  it  to  dry  before  coming  in  contact  with  moisture. 
Ligatures  may  then  be  fastened  to  the  teeth  without  fear  of 
slipping. 

To  rotate  teeth,  double  the  silk,  pass  the  loose  ends  through 
the  loop  and  apply  it  to  the  tooth  to  be  rotated  and  fasten  the 
end  to  a  bicuspid  or  molar.  To  regulate  the  six  anterior  inferior 
teeth  make  a  figure  of  8  knot  (Fig.  328).    Figure  of  8  knot  may 


SURGICAL    CORRECTIONS.  469 

be  used  with  the  upper  teeth  in  the  same  manner.  Teeth  may 
be  moved  in  or  out.  The  ingenuity  of  the  operator  will  devise 
other  operations  on  similar  principles. 

Dr.  Guilford's  retainer  consists  of  a  band  of  gold  or  platinum 
(Fig.  329)  swaged  or  fitted  accurately  to  the  tooth  and  of  suffi- 
cient strength  to  resist  the  rotary  strain  and  friction  in  mastica- 
tion. By  trimming  the  labial  surfaces  as  narrow  as  compatible 
with  strength,  the  band  will  not  appear  conspicuous.  The  bands, 
bars  or  levers  may  be  therefore  firmly  soldered  for  rotating  or 
retaining  the  teeth  after  regulating.  Fig.  330  shows  the  appli- 
cation of  two  of  these  bands  when  two  teeth  are  secured  in 
position  by  a  bar  extending  past  fixed  teeth  on  both  sides.  When 
two  or  more  teeth  are  to  be  held  in  position,  the  bands  may 
be  secured  to  the  bicuspids  or  molars  on  both  sides  and  a  bar 


Fig.  331. 

of  gold  extended  from  one  to  the  other,  upon  the  lingual  or 
labial  surface,  as  illustrated  in  Fig.  331.  "Platinum  bands  were 
fitted  to  the  two  cuspitls  and  these  were  connected  by  a  very 
thin  platinum  wire  passing  along  and  conforming  to  the  outline 
of  the  labial  surfaces  of  the  incisors."  A  method  of  retaining  two 
or  more  teeth  in  position  is  illustrated  in  Fig.  332.  It  consists 
of  bands  of  gold,  platinum  or  German  silver,  made  in  such  a 
manner  that  only  one  thickness  of  the  metal  goes  between  the 
teeth.  This  was  a  case  where  the  four  anterior  teeth  were  held 
in  place  by  uniting  them  to  the  cuspids.  Bands  made  in  this 
manner  do  not  leave  spaces  between  the  teeth. 

Talbot's  retainer  consists  of  a  band  of  platinum  or  gold  fitted 
to  the  tooth  or  teeth,  with  a  tube  of  the  same  material,  the  width 
of  the  tooth,  soldered  lengthwise  of  the  band,  as  illustrated  in 
Fig.  333.    The  band  is  fastened  to  the  tooth  with  zinc  oxyphos- 


470 


IRREGULARITIES    OF    THE    TEETH. 


phate  and  a  piece  of  gold,  platinum  or  piano-wire  is  passed 
through  the  tube  and  allowed  to  come  in  contact  with  the  sur- 
face of  a  firm  tooth.  Should  the  tooth  that  has  been  regulated 
move,  the  wire  may  be  so  bent  that  the  tooth  is  restored  to  its 
proper  position.  Two  or  more  teeth  may  be  retained  at  any 
locality  in  the  mouth  in  the  same  manner.  The  tube  may  be 
attached  to  the  labial,  buccal,  palatine  or  lingual  side  of  the  band, 
according  to  the  requirements  of  the  case. 

After  the  retaining  appliance  has  been  cemented  to  the  teeth, 
tincture  of  iodin  should  be  applied  every  other  day  to  reduce  the 
inflammation   in  the  alveolar  process.     This  will  require  from 


two  to  four  weeks.  Two  elements  governing  the  time  required 
to  retain  the  plate  upon  the  teeth  are,  first,  the  age  of  the  patient ; 
second,  the  nature  of  the  operation.  The  time  cannot  be  defi- 
nitely stated  for  all  persons,  even  of  the  same  age  and  condition 
of  cases ;  approximation  only  is  possible.  In  young  and  healthy 
persons,  in  whom  reconstruction  of  tissue  is  rapid,  the  retainer 
will  be  needed  but  a  short  time.  If  the  superior  or  inferior  arches 
have  been  enlarged  a  retaining  plate  must  be  worn  until  all  the 
teeth  have  accommodated  themselves  to  their  new  position — a 
period  that  will  vary  from  six  months  to  a  year. 

Where  the  teeth  have  been  forced  into  the  arch  little  or  no 
retention  will  be  required,  the  pressure  of  the  lips  and  cheeks 
often  being  all  that  is  necessary.     Occlusion  of  the  teeth  of 


SURGICAL    CORRECTIONS.  '  471 

the   opposite  jaw  aids  greatly  in  retaining  the  bicuspids  and 
molars. 

The  most  difficult  teeth  to  retain  are  those  that  have  been 
rotated  in  their  sockets.  The  difficulty  of  correcting  the  ten- 
dency to  return  to  their  original  positions  is  so  great  that  the 
retainers  must  be  kept  in  place  from  one  to  two  years  and  occa- 
sionally even  longer.  The  operator  will  have  to  use  his  best 
judgment  as  to  the  proper  time  to  remove  them.  The  number  of 
teeth  being  moved  does  not  affect  the  time  required,  as  the 
bone  is  as  rapidly  deposited  in  one  part  of  the  jaw  as  another. 
The  health  of  the  patient  will  have  considerable  influence  in  the 
time  required.  A  strong,  robust  person  will  recover  from  the 
operation  more  rapidly  than  one  that  is  angemic.  The  retainer 
should  remain  as  long  as  circumstances  will  warrant,  when  a 
model  should  be  secured.  After  the  lapse  of  not  longer  than  a 
day  an  examination  should  be  made  and  the  appliance  adjusted. 


Fig.  333. 

If  the  teeth  have  not  deviated,  a  week  may  elapse  before  making 
another  examination,  when  the  appliance  should  again  be 
adjusted.  These  examinations  should  be  continued  until  the 
operator  is  satisfied  the  teeth  are  secure.  If  the  teeth  should 
move,  the  retainer  must  be  replaced  and  allowed  to  remain  from 
three  to  six  months,  when  it  can  be  removed  and  if  any  devia- 
tion is  noted,  it  should  be  returned  and  worn  until  the  teeth  will 
remain  as  desired. 

The  movement  of  the  teeth  is  always  a  predisposing  cause 
of  interstitial  gingivitis.  The  interstitial  gingivitis  set  up  in  the 
alveolar  process  is  often  difficult  to  reduce.  Occasionally  a  low 
form  of  inflammation  will  remain  many  years,  if  not  throughout 
life.  The  use  of  iodin  is  here  indicated.  It  is  a  good  plan  to  use 
it  in  all  cases  after  the  teeth  have  been  properly  secured  in  place. 
The  tissues  will  recover  much  more  rapidly  and  the  chances  of 
success  more  satisfactory. 


APPENDIX. 


TABLE   I. 


Crania  of  Modern  and  Ancient  Races :    Hunterian  and  Oxford 

University   Museums  and  Private  Collections. 

By  Dr.  Mummery. 


No. 

LATERAL 

DIAMETER. 

MODERN  AND  ANCIENT 
RACES 

Minimum. 

Maximum. 

Average. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

Esquimaux  

69 
56 
23 
19 
38 
79 
21 
67 

132 
33 
24 
27 

152 
71 
33 
49 
29 

236 
92 

68 
32 
59 

44 

143 
76 
36 

2.375 
2.375 
2.375 
2.500 
2.500 
2.375 
2.375 
2.500 
2.375 
2.375 
2.375 
2.250 
2.250 
2.125 
2.125 
2.375 
2.125 
2.250 
2.500 

2.125 
2.125 
2.125 

2.125 

2.125 
2.250 
2.125 

60.32 
60.32 
60.32 
63.50 
63.50 
60.32 
60.32 
63.50 
60.. 32 
60.32 
60.32 
57.14 
57.14 
53.97 
53.97 
60.32 
53.97 
57.14 
63.50 

53.97 
53.97 
53.97 

53.97 

53.97 
57.14 
53.97 

2.750 
2.750 
2.625 
2.750 
2.875 
2.625 
2.625 
2.875 
2.750 
2.625 
2.750 
2.625 
2.750 
2.500 
2.750 
2.875 
2.375 
2.750 
2.875 

2.625 
2.500 
2.500 

2.500 

2.625 
2.625 
2.625 

69.85 
69.85 
66.68 
69.85 
73.02 
66.68 
66.68 
73.02 
69.85 
66.68 
69.85 
66.68 
69.85 
63.50 
69.85 
73.02 
60.32 
69.85 
73.02 

66.68 
63.50 
63.50 

63.50 

66.68 
66.68 
66.68 

2.562 
2.562 
2.500 
2.625 
2.687 
2.500 
2.500 
2.687 
2.562 
2.500 
2.562 
2.437 
2.500 
2.312 
2.437 
2.625 
2.250 
2.500 
2.687 

2.375 
2.312 
2.312 

2.312 

2.375 
2.4.37 
2.375 

65.07 

NoKTK  Americans  (Coast) . . 
North  Americans  (Interior) 
South  Americans  (Chili)  . . . 
Fiji  Islanders 

65.07 
63.50 
66.67 
68.26 

Polynesians  (Various) 

Sandwich  Islanders 

New  Zealanders 

63.50 
63.50 

68.26 

Australians 

65.07 

Tasmanians 

63.50 

M.-VLAYS 

65.07 

Chinese 

61.91 

East  Indians  (North) 

East  Indians  (South) 

Africans  (East) 

63.49 
58.73 
61.91 

Caffres  

66.67 

BosjESMEN  and  Hottentots 
Africans  (West) 

57.14 

63.50 

Ash ANTE es 

68.26 

Ancient  BRiTONs(Dolicho-  ) 
cephaHc)  f 

60.32 

ANciENTBRiTONs(Brachy-  } 
cephalic) f 

Ancient   Britons  (Canon  [ 
Greenwell's  Explorations)  ) 

Ancient  Britons  (Miscel-  ) 
laneous) ) 

Romano-Britons 

Anglo-Saxons 

Ancient  Egyptians 

57.73 
58.73 

58.73 

60.32 
61.91 
60.32 

473 


474 


APPENDIX. 


TABLE  II. 

Crania:  Peabody  Museum,  Harvard  University;  Academy  of 
Natural  Sciences,  Philadelphia ;  Davenport  Academy ; 
Army  Museum ;  Roman,  French,  and  English  Crania  in 
European  Museums  and  Private  Collections ;  Miscellaneous 
Crania.  By  Doctors  Peirce,  Newton,  Schuhmann,  Barrett, 
Pratt,   Betty,  and  Talbot. 


RACE. 


Europeans  —  Ancient  and( 
Modern  Romans,  Italians,  K 
French,  English ( 

Sandwich  Islanders | 

Ancient  Peruvians < 

Ancient  Californians, 
from  Santa  Cruz  Islands, 
Coast  of  California;  Santa 
Catalina  Island,  Brazil; 
Nicaragua,  St.  Miguel 

Mexicans 


Californian  Indians ] 

Mound  Builders,  Mounds  ( 
in  Kentucky  and  Tennes-  -( 
see ( 

Stone  Grave  People,  Cum-  ( 
berland  Valley,  Tennessee; 
Illinois      River,      Indiana, 
Arkansas,     Michigan,    and 
various  places 

Indians  —  North    American. 
Different  Tribes 


Negro — Rio  de  Favino 

Flat  Heads  from  Oregon, 
Washington,  Gulf  of  Geor- 
gia, Peru 

From    San    Lorenzo     Cave,  j 
Mexico / 

From  Caves  in  Tennessee, 
Kentuckj',  Mexico 

Esquimaux  from  Labrador,  j 
Norton  Sound / 


No. 

Sex. 

276 

? 

36 

M 

.SO 

F 

26 

M 

26 

F 

S 

? 

1.37 

M 

124 

F 

117 

? 

M 

M 

38 

F 

27 

? 

29 

M 

26 

F 

56 

M 

47 

F 

57 

? 

87 

M 

89 

F 

11 

? 

17 

M 

n 

F 

191 

? 

1 

3 

M 

2 

F 

18 

•? 

4 

M 

3 

F 

4 

M 

9 

■? 

3 

V 

40 

? 

2 

M 

L.A-TERAL  DIAMETER. 


Minimum.  <  Maximum.     Average. 


In.      Mm. 


1.94 '49 
2.06  52 
1.88  47 
2.13  53 
2.06 
2.22 
2.00 
1.88 


2.00  50. 


2.06 
2.06 

1.94 
2.06 
2.06 
2.06 
2.00 
2.06 


52.32 
52.32 

49.19 
52.. 32 
52.. 32 
52.32 
50.80 
52.32 


2.13  53.95 
1.88  47.62 
2.13  53.95 


2.13 
2.13 
1.88 
2.19 
2.25 


2.06 
1.75 
2.25 


In. 


2.69 
2.-37 
2.44 
2.50 
2.37 
2.50 
2.63 
2.56 
2.56 

2.63 
2.44 

2.50 
2.50 
2.37 
2.63 
2.50 
2.69 

2.69 
2.50 
2.44 

2.50 
2.31 
2.63 
2.19 
2.50 
2.44 
2.75 
2.37 
2.. 37 
2.19 


Mm. 


68.26 
60.30 
61.90 
63.50 
60.30 
63.50 
66.67 
65.08 
65.08 


66.67  2.31 
61.90  2.25 


In. 


2.34 
2.20 
2.08 
2.29 
2.20 
2.30 
2.30 
2.22 
2.30 


63.50 
63.50 
60.30 
66.67 
63.50 
68.26 


2.31 
2.31 
2.22 
2.33 

2.28 
2.39 


68.26  2.42 
63.50!  2.28 
61.90  2.28 


2.25 
2.63 
2.31 


63.50 
58.84 
66.67 
55.56 
63.50 
61.90 
69.85 
60.30 
60.30|2 
55.56  2 
2 


57.13  2 
66.67  2 
58.84  2 


Mm. 


58.84 
55.95 
52.81 
58.17 
55.95 
58.45 
58.45 
56.34 
58.45 

58.84 
57.14 

58.84 
58.84 
56.34 
59.48 
57.92 
60.70 

61.90 
57.92 
57.92 

58.45 
56.69 
58.84 
55.56 
62.31 
57.92 
64.29 
58.45 
55.95 
54.. 38 
56.69 
55.56 
56.69 


28 '57.92 


APPENDIX. 

TABLE  II— Continued. 


475 


RACE. 


Hindoos. 


Herney  Islanders  . 
Hawaiian  Islander. 


Negroes,  African  Negroes..  -! 

Zulus,  South  Africa j 

Probably  Africans 

Negro  Criminal  (Giles)  

Aleutian  Islander 

Guanche 

Pegu,  Burmah 

Mauritian  Dwarf 

Unknown j 

Fiji  Islanders 

Loo  Choo  Islander 

Burmese 

Marquesas  Islanders 

Assiniboin 

Kankakee  

Malay 

Tahitian 

Tatlit  Koochin 

Laplanders  

Japanese 

Parsee  

Australians 

Armenians 

Samoan  Islander 

Ancient   Egyptian    (Egyp-  [ 

tian  Type) \ 

Ancient  Egyptian  (Negroid  } 

Type) f 

Copt   

Egyptian  Negroes 

Arab 

Choctaw  and  Negro 

Hispano-Peruvian 

Dutch 

Anglo-American 

Recent  Crania,  Pa.  (?) 


Total 1840 


No. 


1 
1 
3 
3 
1 
1 
2 
9 

79 
1 
1 
2 
1 
1 
1 
1 
1 
3 
5 
2 
1 
1 
4 
3 
5 

13 
2 
2 
2 
1 
2 

10 
4 
1 

45 

11 

1 
3 
2 
1 
2 
1 
1 

90 


Sex 


LATERAL  DIAMETER. 


Minimum. 


In. 


2.13 
2.22 
2!o6 
2.19 
2.13 
2.31 
2.13 
1.88 
2.25 
2.25 
2.44 
2.00 
2.31 
2.13 
2.06 
2  19 
2.19 
2.31 
1.88 
2.31 
2.37 
2.47 
2.28 
2.28 
2.16 
2.16 
2.25 
2.22 
2.37 
2.37 
1.97 
2.09 
2.00 
2.25 
1.88 
1.88 

2.13 

13 


Mm. 


53.95 
56.35 
52.32 
55.56 
53.95 
58.84 
53.95 
47.62 
57.13 
57.13 
61.90 
50.80 
58.84 
53.95 
52.32 
55.56 
55.56 
58.84 
47.62 
58.84 
60.30 
62.70 
57.92 
57.92 
54.75 
54.75 
57.13 
56.35 
80.30 
60.30 
50.07 
53.13 
50.80 
57.13 
47.62 
47.62 

53.95 


2. 

1.88 
2.19 
2.19 i55. 
2.13  [53. 
2.56  65. 


2.50 
1.97 


Maximum. 


In. 


2.13 
2.22 
2.37 
2.50 
2.13 
2.31 
2.50 
2.47 
2.25 
2.25 
2.44 
2.25 
2.31 
2.13 
2.06 
2.19 
2.19 
2.44 
2.31 
2.44 
2.37 
2.47 
.44 
.37 
.31 
.53 
2.47 
2.34 
2.50 
2.37 
2.00 
2.69 
2.09 
2.25 

90 


2.50 
2.69 


Mm. 


53.95 
56.35 
60.30 
63.50 
53.95 
58.84 
63.50 
62.70 
57.13 
57.13 
61.90 
57.13 
58.84 
53.95 
52.32 
55'.  56 
55.56 
61.90 
58.84 
61.90 
60.. 30 
62.70 
61.90 
60.30 
58.84 
64.29 
62.70 
59.57 
63.50 
60.30 
50.80 
68.26 
53.13 
57.13 
56.35 
63.50 

68.26 

53.95 
53.95 
58.84 
55.56 
22!56.35 
56165.08 
50r63.50 
50  63.50 


47.62  2.69  68.26  2.28  57.94 


Average. 


In. 


2.13 
2.22 
2.25 
2.33 
2.13 
2.31 
2.31 

2!  25 
2.25 
2.44 
2.13 
2.31 
2.13 
2.06 
2.19 
2.19 
2.37 
2.13 
2.37 
2.37 
2.47 
2.36 
2.31 
2.25 
2.37 
2.36 
2.28 
2.44 
2.37 
1.98 
2.31 
2.06 
2.25 
2.06 
2.20 

2.37 

2.13 
2.01 
2.25 
2.19 
2.17 
2.56 
2.50 
2.30 


Mm. 


53.95 
56.35 
57.14 
59.13 
53.95 
58.84 
58.84 
57.58 
57.13 
57.13 
61 .  90 
53.95 
58  84 
53.95 
52.32 
55.56 
55.56 
60.30 
53.95 
60.30 
60.. 30 
62.70 
59.91 
58.84 
57.14 
60.30 
59.91 
57.92 
61.90 
60.30 
50.40 
58.84 

.29 
57.13 

.59 
55.95 

60.30 

53.95 
51.05 
57.14 
55.56 
55.16 
65.08 
63.50 
58.45 


476 


APPENDIX. 


TABLE   III. 

Measurement  of  the   Superior  Maxilla   in   Life. 


LATERAL  DIAMETER. 


RACE 


Residents    of   Athens, 
Greece 

Stockholm,  Sweden 
Copenhagen,  Denmark 
Brussels,  Belgium 
Warsaw,  Poland 

China 

East  Indians 
Italians 
Santiago,  Chile 
London,  England 
Dublin,  Ireland 
American-born  Negroes 


Dispensary —  Philadelphia, 
Baltimore,  and  Boston. . . . 

Burlington,  Vermont 

Boston,  Massachusetts 

New  York  City 

Chicago  and  Illinois 

Marshpee  Indians.  . . 

Total '8296 


T 1.87 '47.54' 2.41  62.08  2.14  51.19 


APPENDIX. 


477 


TABLE  IV. 


RACE. 


Ancient  and  Modern  Ro- 
mans, Lake  Dwellers, 
French  prior  to  nineteenth 
century 

Sandwich  Islanders 


Ancient  Peruvians. 


Ancient  Californians. 
Californian  Indians.  .. 
Mound  Builders.  . .    . . 


Negro — Rio  de  Favino 

Flat  Heads  from  Oregon,  ( 
Washington,  Georgia,- 
Peru ( 

From  San  Lorenzo  Cave,  j 
Mexico t 

From  Caves  in  Tennessee,  ) 
Kentucky,  Mexico ) 

Esquimaux  from  Labrador,  \ 
Norton  Sound ( 

Hindoos - 


Herney  Islanders  . 
Hawaiian  Islander 


Negroes,  African  Negroes. 

Zulus,  South  Africa 

Probably  Africans 

Negro  Criminal 


No. 


Stone     Grave     People — \ 
Cumberland  Valley i 

Indians -( 


31 

30 

26 

29 

122 

104 

2 

26 

32 

130 

32 

30 

157 

83 

1 

83 

80 

7 

110 

58 

3 

1 

3 

2 

1 

4 

3 

4 


.Sox, 


M 
F 

M 
F 
M 
F 

? 

M 
F 

? 

M 
F 

M 
F 

? 

M 
F 

■? 

M 
F 

? 
? 

M 
F 

? 

M 
F 

M 

? 

F 

? 

M 
M 

? 

F 
M 

? 

M 

M, 
? 

F 
F 
M 
F 
M 


ANTI':i<()  I'OS'll'-.RIOR 
iJlAME'IER. 


Minimum. 


In.      Mm. 


1.69 
1.56 

1.63 
1.63 
1.56 
1.56 
1.69 
1.63 
1.69 


1.69 
1.69 
1.56 
1.63 
2.00 
1.63 
1.63 
1.88 
1.75 
1.38 
1.81 
2.06 
1.88 
1.88 
2.00 
1.69 
1.75 
1.69 


1.75 


1.69 
1.69 


1.81 

1.88 


2.00 
2.06 


1.94 
2.00 


2.19 


42.86 
39.69 


86 


69^2 

28 

80 

28 

28 

62 

46 

09 

04 


46 


44.46 


42.86 
42.86 


46.04 
47.62 


50.80 
52.32 


49.14 

50.80 


55.56 


Maximum. 


In.      Mm. 


2.00 
2.06 


2.00 


2.13 
2.00 


1.81 
2.00 


2.00 
2.13 


1.94 
2.00 


2.19 


50. 80 
52.32 


50.80 


53.95 
50.80 


46.04 
50.80 


50.80 
53.95 


49.14 
50.80 


55.56 


Average. 


In.      Mm. 


1.86 
1.83 


1.83 


1.72 

1.69 


1.81 
1.92 


2.00 
2.09 


1.94 
2.00 


2.19 


47.23 
46.43 

48.38 
46.43 
47  62 
45.64 
46.83 
48.02 
47.23 
46.40 
48.38 
46.43 
50.80 
48.02 
50.80 
50.00 
48.41 
49.21 
50.55 
47.44 
48.38 
52.32 
50.80 
49.21 
50.80 
46.43 
46.43 
45.64 


46.43 


43.65 
42.86 


46.04 

48.81 


50.80 
53.18 


49.14 
50.80 


55.56 


478 


APPENDIX. 


TABLE  IV— Continued. 


RACE. 


Aleutian  Islander 

GUANCHE 

Pegu,  Burmah  

Mauritian  Dwarf 

Unknown j 

Fiji  Islanders ] 

Bavarian  . . .'. j 

New  Zealanders j 

Austrians -j 

Chinese - 

Japanese j 

Australians ■ 

Samoan  Islander 

Gallo-Roman \ 

Romano-British 

Whites - 

Egyptian 

American  Negroes j 

Marshpee  Indians 

Recent,  Illinois \ 

Total 


No. 


2015 


Sex. 


ANTERO-POSTERIOR 
DIAMETER. 


Minimum. 


In. 


2.13 
1.63 
1.88 
2.13 
1.81 
1.69 
2.28 
2.09 
2.13 


2.09 
1.94 
1.91 
2.06 
2.25 
1.75 
1.94 
2.00 
1.88 
1.84 
1.75 
2.19 
1.81 
2.03 
2.06 
1.75 

1.56 


1.66 


Mm. 


39.69 


45.84 


Maximum. 


In. 


2.13 
1.63 
1.88 
2.13 
2.06 
2.00 
2.28 
2.09 
2.13 
1.81 
2.13 
2.03 
2.01 
2.13 
2.09 
1.94 
1.91 
2.06 
2.25 
2.28 
1.94 
2.00 
1.88 
1.84 
2.13 
2.19 
1.81 
2.19 
2.13 
2.07 

2.19 


2.04 


Mm. 


53.95 
41.28 
47.62 
53.95 
52.32 
50.80 
57.92 
53.19 
53.95 
46.04 
53.95 
51.56 
51.05 
53.95 
53.19 
49.25 
48.23 
52.32 
57.13 
57.92 
49.25 
50.80 
47.62 
46.74 
53.95 
.55.56 
46.04 
55.56 
53.95 
52.29 

55.56 


Average. 


In. 


2.13 
1.63 
1.88 
2.13 
l!95 
1.91 
2.28 
2.09 
2.13 
1.81 
1.92 
1.93 
1.96 
1.94 
2.09 
1.94 
1.91 
2.06 
2.25 
2.01 
1.94 
2.00 
1.88 


1 
1 
2 
1 
2 
2 
1.98 

1.84 


51.42,  1.78  49.33 


Mm. 


53.95 
41.28 
47.62 
53.98 
49.60 
48.41 
.57.92 
53.19 
53.95 
46.04 
48.76 
49.00 
49.78 
49.25 
53.19 
49.25 
48.23 
52.32 
57.13 
51.05 
49.25 
50.80 
47.02 
46.74 
50.29 
55.56 
46.04 
53.95 
52.73 
50.27 

46.74 


APPENDIX. 

TABLE   V. 


479 


RACli. 


Ancient  and  MonF.KN  Ro- 
mans; Lake  Dwellers; 
French  prior  to  nineteenth 
century  

Sandwich  Islanders 


Ancient  Peruvians. 


Ancient  Californians -j 

Californian  Indians -j 

Mound  Builders 

Stone     Grave     People  — 
Cumberland  Valley 


Indians, 


Negro — Rio  de  Favino 

Flat  Heads  from  Oregon,  ( 
Washington,  Gulf  oi  ■} 
Georgia,  Peru ( 

From  San  Lorenzo  Cave,  j 
Mexico ( 

From  Caves  in  Tennessee,  j 
Kentucky,  Mexico ) 

Esc)UI^L\ux  from  Labrador,  j 
Noi'ton  Sound 


Hindoos. 


Herney  Islanders  . 
Hawaiian  Islander. 


No. 


Negroes,  African  Negroes. .  -I 

Zulus,  South  Africa j 

Probably  Africans 

Negro  Criminal  (Giles) 

Aleutian  Islander 


34 
30 

25 

26 

137 

12-i 

17 

34 

38 

29 

26 

56 

47 

7 


HEIGHT  OF  VAULT, 


Minimum. 


In.      Mm. 


.31 

.37 
.31 
.25 
.37 
.44 
.44 
.44 
.41 
.44 
.44 
.44 
.41 
.41 
.37 
.37 
.44 
.41 
.50 


.50 
.50 
.50 
.50 
.44 
.53 


.47 


Maximum. 


In.      Mm. 


6.35 
7.65 

9.39 

7.62 

6.35 

9.39 

11.17 

11.17 

11.17 

10.45 

11.17 

11.17 

11.17 

10.45 

10.45 

9.39 

9.39 

11.17 

10.45 

12.70 


12.70 
12.70 
12.70 
12.70 
11.17 
13.46 


.50 
.50 


.44 
.44 


.63 
.53 


.44 
.50 
.75 
.44 
.50 
.31 


11.93 


12.70 
12.70 


11.1 
11.17 


16.00 
13.46 


.69 
.63 

.75 
.69 
.81 
.75 
.63 
.69 
.75 
.69 
.69 
.72 
.69 
.66 
.88 
.75 
.56 
.69 
.59 
.63 


.75 
.56 
.50 
.69 
.66 
.53 


.53 


.56 
.50 


17.52 
16.00 

19.05 

17.52 

20.57 

19.05 

16.00 

17.5 

19.05 

17.5- 

17.52 

18.29 

17.52 

16.78 

22.35 

19.05 

14.23 

17.52 

14. 

16.00 


Average. 


In.      Mm. 


19.05 
14.23 
12.70 
17.52 
16.78 
13.46 


13.46 


14.23 
12.70 


.69 
.63 


.63 
.63 


11.17 
12.70 
19.05 
11.17 
12.70 
7.62 


.44 
.50 
.75 
.50 
.50 
.31 


17.52 
16.00 


16.00 
16.00 


11.17 
12.70 
19.05 
12.70 
12.70 
7.62 


.53 

.48 

.55 
.52 
.57 
.57 
.49 
.55 
.55 
.54 
.52 
.55 
.56 
.51 
.60 
.55 
.50 
.57 
.47 
.56 
.50 
.65 
.53 
.50 
.60 
.54 
.53 


13.46 
12.19 

13.97 
13.21 
14.47 
14.47 
12.45 
13.97 
13.97 
13.71 
13.21 
13.97 
14.23 
12.95 
15.02 
13.97 
12.70 
14.47 
11.93 
14.23 
12.70 
16.51 
13.46 
12.70 
15.02 
13.71 
13.46 


.51 


12.95 


.53 
.50 


13.46 
12.70 


.60    15.02 
.57    14.47 


.63 
.57 


16.00 
14.47 


.44 
.50 
.75 
.47 
.50 
.31 


11.17 
12.70 
19.05 
11.93 
12.70 
7.62 


480 


APPENDIX. 

TABLE  V— Continued. 


R.A.CE. 


Xo. 


Sex. 


GUANCHE 

Pegu,  Burmah 

Mauritian  Dwarf. 


Unknown  

Marshpee  Indians. 


1 
1 
3 
5 
46 


Total I  954 


HEIGHT  OF  VAULT. 


Minimum.     Maximum. 


In. 


Mm.  I    In. 


Mm. 


1     F      .44   11.17    .44    11.17    .44    11.17 


.50 
.50 
.53 


Average. 


In. 


Mm. 


12.70  .50  12.70  .50 
12.70  .50  12.70'  .50 
13.46    ..56    14  23    .54 


12.70 
12.70 
13.71 


.53    13.46    .69    17.52    .57  il4.47 
.41  ,10.45    .63   16.00    .52  :i3.22 


.44  111.36    .62   15.48    .51   13.57 


[The  averages  in  Table  I  are  maximum  and  minimum  figures  alone,   while 
those  in  the  other  tables  are  deduced  from  the  total  of  all  the  measurements.] 


TABLE  VI. 


No. 

Lateral. 

Anteroposterior. 

Height  of  Vault. 

1 
2 
3 
4 

5 
6 

1.31  In.  =  33.22  Mm. 
1.25    "  =31.75    " 
1.37    "  =34.79    " 
1.56    "  =39.51    " 
1.62    "  =41.12    " 
1.25    "  =31.75    " 

2        In.  =50.80  Mm. 
2.12    "  =53.84    " 
2          "  =50.80    " 
2.37    "  =60.70    " 
2.25    "  =57.15    " 
2.12    "  =53.84    " 

0.37  In.  =   9.42 Mm. 
0.62    "  =15.74    " 
0.43    "  =10.92    " 
0.75    "  =19.05    '.' 
0.50    "  =15.24    " 
0.31    "  =    7.87    " 

TABLE  VIL 

THIRTY-FOUR    EUROPEAN    SKULLS. 


Length  in 
Millimeters. 

Width  in 
Millimeters. 

Height  in 
Millimeters. 

Maximum 

58 
40 

49 

42 

31 

*35 

15 

Minimum .... 

Average 

5.5 
*9 

TABLE  VIII. 


THIRTY-TWO     MIXED     SKULLS. 


Length  in 
Millimeters. 

Width  in 
Millimeters. 

Height  in 
Millimeters. 

Maximum 

65 
43 
54.9 

40 

29 

*35 

18 

Minimum 

6 

Average    

*12 

'Taken  at  second  bicuspid. 


APPENDIX. 


481 


TABLE   IX. 

Examination  of  criminal  youth  at  Elmira,  N.  Y.  (i,oi8),  and 
Pontiac,  111.  (414). 


Jaws. 

Teeth. 

Alveolar 
Process. 

4J 

Tuber- 

Abnor- 

6 

OJ 
D, 
re 

> 

> 

u 

re 

> 
E 

_a3 

re 
c/} 

St/3 

■a 
re 

S 

C/3 

re 
E 
0 

7. 

_re 

OJ 

_re 
3 

u 
u 

cles. 

"re 
E 

u 

0 

mal. 

c 

e 

OJ 

1/1 

Si 

< 

lS. 
(u  a 

QO 

6  a 

Illinois    State 

Reformatory. 

414 

75 

71 

3 

66 

63 

16 

171 

123 

342 

13 

452 

371 

93 

1 

New  York  State 

Reformatory. 

1,018 

381 

49 

1 

157 

26 

. . .  422'220  821 

26 

1,015 

968 

73 

TABLE   X. 

The  following  table  shows  the  different  deformities  of  the 
jaws  and  teeth  found  among  477  criminals  at  Joliet,  111.: 


d 
'A 

X 

a; 

re 

E 

u 

0 

5^ 

re 
'-) 

OJ 

u 
re 

c  re 
3  1- 

u  OJ 

3  u 
D-D 

3 
re 
> 

S 

T3 

Partial 
V-Shaped 
Arch. 

> 
E 

-a 

.    OJ     . 

a;  a.c 
-a  "=  ^^ 

if} 

re 
•-) 

"re 

E 

72 

ret/3 

—■a 
E  '^ 

72 

468 
9 

M 
F 

163 
9 

66 
9 

17 

5 

70 

13 

79 

19 

59 

30 

92 

24 

Per  cent. 

36.06 

15.72 

3.56 

1.04 

14.67 

2.70 

16.56 

3.98 

12.36 

6.29 

19.28 

5.03 

TABLE  XI. 

JAWS    OF    PROSTITUTES. 


3 

3    -d 
;5 

j=  a>  3 

"0^ 

0) 
Q 

re 
j= 
73 

> 

0) 

Q 
re 

■-7} 

OJ 
Q 
re 

72 

-a 
re 

72 

a; 

rtt55 

-a 
—-a 

£72 
72 

Average. . 
Per  cent. . 

2.00 

1.69 

1.06 

49 

io 

i7 

7 

27 

10 

10 

TABLE  XII. 

The  following  table  shows  the  results  of  the  examination  of 
the  jaws  and  teeth  of  700  insane  cases  of  patients  in  Chicago, 
111.    (Cook  County),  Insane  Hospital. 


6 

X 

72 

0 

re 

"—) 

OJ 
he 

re 

0  re 
«^ 
3  1-- 

Protrusion 
Upper  Jaw. 

re 
> 

T3 

72^ 
> 

a 

—  "^  r-: 
re>< 

a, 

•a 

.  0  . 

OJ  C.J3 
72 

::r  a! 
re  a> 
EH 
7: 

430 
270 

M 
F 

317 
139 

10 

-    8 

4 
6 

2 
4 

18 
26 

12 
14 

29 

18 

3 

9 

5 
2 

700    1 

486    1     18 

10 

6 

44 

26 

47 

12 

7 

32 


482 


APPENDIX. 


"3 

■*-> 

a, 

en 

O 

G 

ui 

S 

Bi 
O 
(b 

a 
Q 

VS. 

^-  ic  >.t  :c  ^H  r-  'M  o  cc    • 
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CO 

CO 

T— 1 

CI 

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I— 1 1— 1 

02- 

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r.  ii 

to 

00  ■<*  r-  O  O  O  fC  O  CI      • 

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1-hCI 

> 

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'.'.'.'.'.       T^        '.       f  (M 

;=!  o 

a) 

Mi-IOOCMJCCSOO-* 

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ClrH      XO 
i-hCJ 

1— t  _t« 

a;  'O 

1*-.  "i' 
0-5 

> 

r-liMCSCg-^r-IOi-teCi-li-l 
I— 1 

:  :  :-^-^ 

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I-H 

ID" 

o<z 

<9 

> 
<5 

m ci icTi oc  o ^ '^ iM 
vz  m  Ct  i,t  O  iC  lO  o  o 

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s 

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If: 

t—  01  r-  Lt  X  i~  i^  t~- 1- 

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cr.  I-  S-.  r-  sr.  t^  00  t-  cj 

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Cl  -^     O  — ' 

cici    cici 
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c  c;    r-r- 

cici       r-rH 

ci 

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o  00  .-1  •--  X  00  o  X  o 
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the  resii 
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tr:  CI  —  r-  <c  •--  ct  ci  U2 

cicicicicicici  ci  ci 

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•  •  t- " *: '" 

•  recici 

•  -cicici 

gc^    Sx 
Cl  Cl    ci  ci 

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(9 

st,2feS^;s-s- 

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r- 1  rH 

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c 

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111    « 

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111   1 

—               * 

Eh 

■  ^        -^       c' 
rnrH         CO         El 


AI'I'ENDIX. 


483 


The  examinations  were  made  by  able  dentists  and  myself 
in  the  following-  named  institutions: 

Asylum  for  Idiots  of  the  State  of  New  York,  at  Syracuse; 
Massachusetts  School  for  Feeble-minded,  at  South  Boston; 
Illinois  Asylum  for  Feeble-minded  Children,  at  Lincoln;  Asvlum 
for  Idiots,  Randall's  Island,  N.  Y.;  Minnesota  Training-school 
for  Idiots  and  Imbeciles,  Faribault;  Kansas  State  Asylum  for 
Idiots  and  Imbeciles,  South  Winfield;  Cook  Countv  Insane 
Asylum,  Dunning,  111.;  Pennsylvania  Institution  for  Feeble- 
minded Chiklrcn,  at  Elwyn. 

The  following  tables  show  the  total  number  of  irregularities 
in  each  grade  and  sex: 

TABLE  XIV. 

DEFORMITIES    IN    THE    JAWS.* 


6 

C3 

E 

u 
O 

a; 
id 
u 

c 
o 

ui-l--) 

c 
o 

Oh 

3 
> 

II 

> 

a 

_  CO    . 

a. 

T3 

;5  ceo 

73 

CC  OJ 

EH 

1,977 

1,095 
55. 3~ 

152 

92 

159 

318 

129 

236 

207 

71 

Per  cent. 

7.6 

4.6 

7.9 

16 

6.5 

11.9 

10.4 

3.5 

*  All  tables  show  irregularities  that  are  the  result  of  small  jaws. 

TABLE  XV. 

Stature  and  weight,  general  population  and  inmates  of  the 
Earlswood,  Royal  Albert,  and  Larbert  Asylums.   (Shuttleworth.) 


Age 

HEIGHT,   INCHES. 

WEIGHT,  POUNDS. 

Last 

Birth- 

dav. 

General 
Population, 

Idiots  AND 
Imbeciles. 

General 
Population. 

Idiots  and 
Imbeciles. 

M. 

F. 

M. 

40.00 
42.25 
44.00 
45.75 
47.50 
49.00 
51.00 
52.50 
54.75 
56.50 
59.25 
60.75 
62.50 
63.25 
63.25 
64.00 
64.25 

F. 

39.50 
41.25 
43.25 
45.25 
47.50 
49.00 
51.00 
53.00 
55.00 
56.50 
58.00 
59.00 
59.25 

59  [56 

M. 

5.5!  06 

60.00 

65.00 

70.00 

77.50 

85.00 

92.50 

102.50 

117.50 

135.00 

142.50 

143.70 

145.00 

146.20 

F. 

M. 

F. 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

41.00 
43.00 
45.00 
47.00 
49.00 
51.00 
53.00 
55.00 
57.50 
60.00 
62.20 
64.00 
65.50 
66.50 
67.00 
67.25 
67.50 

40.55 
42.88 
44.45 
46.60 
48.73 
51.05 
53.10 
55.66 
57.77 
59.80 
60.93 
61.75 
62.52 
62.44 
62.75 
62.98 
63.03 

39.20 

41.70 

47.50 

52.10 

55.50 

62.90 

68  10 

76.40 

87.20 

96.70 

106.30 

113.10 

115.50 

121.10 

123.80 

123.40 

121.80 

39.00 

43.00 

46.50 

50.50 

55.50 

59.00 

64.50 

70.50 

77.00 

85 '.50 

94.50 

103.00 

110.00 

116.00 

120.50 

121.50 

122.00 

37.50 

41.00 

45.00 

49.00 

53.00 

59.00 

66.00 

72.00 

80.00 

88.00 

95.00 

102.00 

106.00 

108.00 

108.50 

108.. 50 

484 


APPF.XDIX. 


TABLE  XV— Continued. 


Age 

HEIGHT. 

INCHES. 

WEIGHT. 

POUNDS. 

Last 
Birth- 

General 
Population 

Idiots  and 
Imbeciles. 

General 
Population. 

Idiots  and 
i.vibeciles. 

M 

F 

M. 

F 

M. 

F. 

M. 

F. 

22 
23 
24 

25-30 
30-40 
40-50 
50-60 

67 .  75 
68!  00 

62.87 
63.01 
62.70 
62.02 

6i!i5 


64.50 
64!  75 

59!  75 

147.50 
148.70 
150.00 
151.20 
152.50 
155.00 
157.50 

123.40 
124.10 

120.80 
120.00 
120.80 
118.60 
104.00 

122.50 

ioo^oo 

TABLE  XVI. 


DEFORMITIES    OF    JAWS    OF    INEBRIATES. 


6 

re 
E 
0 
Z 

re 

0 
u 

re 

re 
> 

T3 

> 

•a 

D 
Q 

re>-< 

Oh 

Semi 
V-Shaped 
Arch. 

Saddle 
Arch. 

Partial 
Saddle 
Arch. 

0 
e  "  r: 

514 

25  A 

6.4 

59.5 

1.5 

24.4 

0.3 

9.3 

13.2 

7.7 

*The  examination  of  inebriates  was  made  in  The  Keeley  Institute,  Dwight  111  ; 
The  Inebriates'  Home,  Ft.  Hamilton,  N.  S:  WashinKton  Home.  Chicago;  Wasli- 
intiton  Mume,  Boston,  and  Dr   Crother's  Institute,  Hartford,  Conn. 


TABLE  XVII. 


DEFORMITIES    IN    JAWS    OF    THE    BLIND, 


One  case  cleft  palate. 


re 
c 

u 

C 

re 
1-1 

OJ 
u 

re 

c 
0 

0-, 

c 
0 

0 
< 

be 
X 

73 
UJ 

> 

i) 

a 

re   . 

re>< 

J5 

—  01 

reo 
in 

107 
100 

M 
F 

53 

52 

8 
8 

9 

7 

10 
5 

20 
18 

4           3 
3           6 

6 
5 

7 
3 

207 

105 

16 

16 

15 

38 

7 

9 

11 

10 

Per  cent. . . . 

50.7 

7.7 

7.7 

7.2 

18.3 

3.3 

4.3 

5.3 

4.8 

In  twenty-seven  examinations  of  congenitally  blind  patients, 
all  possessed  either  deformities  of  the  head,  face,  jaws  or  teeth. 


APPENDIX. 


48^ 


TABLE  XVIII. 

TOTAL    DEFORMITIES    IN     lllb:    JAWS    OT    THK    DF^AK    AND    DUMli. 


d 

2: 

o 

538 
363 

—) 
o 

•_ 

CO 

c 

0 

cu 

o 

£:§4 

c 

116 

89 

C8 
> 

"si 

a- 

T3 

a 
_  re  . 

«>< 

Oh 

.Q  reo 

=  a! 

1,111 

824 

M 
F 

197 
108 

41 
51 

241 
177 

91 

78 

115 

77 

108 
95 

51 

62 

1,935 

nt.... 

901 
45.3 

305 

92 

205 

•  418 

169 

192 

203 

113 

Per  ce 

15.7 

4.7 

10.5 

21.7 

8.7 

9.9 

10.4 

5.8 

Two  cases  cleft  palate. 

TABLE  XIX. 

NEUROSES  OF  DEVELOPMENT  OF  TAWS  OF  SEEM- 
INGLY NORMAL  INDIVIDUALS. 
That  the  deformities  of  the  jaws  of  the  neurotics  and  degen- 
erates as  found  in  our  asyhims  may  be  comparer]  witli  those 
whom  we  meet  in  every-day  hfe,  the  author  examined  tlie  mouths 
of  I, coo  school  chiklren  over  twelve  years  of  age  and  i,ooo  adults, 
patients  and  friends,  with  the  following-  results: 

DEFORMITIES    IN    CHILDREN'S    JAWS. 


d 

1) 

u 

O 

o 

c 
o 

^  &  > 

a, 

c 
o 

a. 

re 
> 

-0 
> 

ID 
Q 

lip 
CL, 

•  «  . 
in 

re   Oy 

EH 

73 

396 
604 

M 
F 

303 
463 

11 

8 

3 

4 

5 
2 

26 
30 

5 
6 

18 
43 

12 
21 

13 
17 

1,000   

766 

19 

7 

7 

56 

11 

61 

33 

30 

Per  cent 

76 

1.9 

.7 

•^ 

5.6 

1.1 

6.1 

3.3 

3.0 

DEFORMITIES    IN    ADULT 

JAWS 

d 

72 

5 
2 

o 
re 

re-g 
> 

Q 
_  re   . 

•-XP 
73 

.1-  u 
73 

11 

•a 

.-TJ 

c  re 
■f. 

284  '     M 
716       F 

211 
403 

9 
23 

32 

48 
62 

10 
19 

10 
50 

10 

8 

14 
29 

27 
24 

9 
25 

1,000  1 

014 

110 

35 

72 

18 

43 

51 

34 

Per  ce 

nt.... 

61 

3.2 

11.0 

3.5 

7.2 

1.8 

4.3 

5.1 

3.4 

486 


APPENDIX. 


APPENDIX. 


487 


X 
H 

EH 


c 

E 
« 

a 
E 

Sanguine. 

Nervo-bilious. 

Sanguine. 

Sanguine. 

Nervous. 

Nervo-sanguine. 

Nervo-bilious. 

Nervous. 

Lymphatic. 

Nervo-bilious. 

Neurotic. 

Neurotic. 

O    . 

S> 

1 

oi  c-l  (M  O  r-  iM  "M  t^  r^  (M  r^  O 
C}  !>}  (M  I-  (M  (M  Ol  tH  T-|(M  QO  r- 

r-l  ,— 1  rH  T-l  tH  1— 1  ,-H  tH  T— 1  i-H          i-H 

d 

oooooooooooo 

in 

O    . 

62 

«  as 

^^ 
Z 

< 

2 

O     •     -lO      -lO      -'O     -oo     • 
CO       •       •  r-{       •!— 1       -fH       -0100       • 

O     •     -r-     -t—     -r^     -oo     • 

lO      •      -O      -iC      -O      •^lO      • 

c 

o    •    -c^    -c^    "S    -c^o    • 

(M      •      -IM      -(M      '(M      -(MC^I      • 

z 

Id     • 

si 

dq 

l—iOOOi'MCftt-OOKtiOiO 

Oi  ^H  lO  -t<  «C  -^  CI  LO  »0  -^  liO  r-H 

" 

cOiOOr-Or-QOOOtOOin 
1— iMOroaocoi— lOOCvlOC-j 

Qcn 

Si 

E 

OOiOiClO-^OOiCTtfiOO 
OOaOi— I^H-^GOCOQO-^QO-^QO 

d 

0  0  011.0100100100-1100 
O  O  CO  Ol  t-  r^  O  O  I--  --H  r-  O 

Ol  Ol  i-H  Ol  rH  Ol  Ol  Ol  1-1  Ol  1—1  Ol 

Q 
t«  OS 

I** 

E 

lO  lO  O  O  •*  O  lO  'O  Ol  O  O  t- 

^H,— (GOlOOOOli— lr-(CV^GOCOfO 

t-I—OfOCOO't— r-0100»0 
lO'OiOCOOO'O'OiO'^DOO 

d 

lO  lO  O  O  Ol  1—  lO  lO  CO  t-  O  00 
OlOlOOi-lfOOlOlOfOO'-H 

OIOIOJOIOIOIOIOIOIOIOIOI 

c 

CiOi  CS35QOOOt-t-OCOlOlO 

1—  r-  1-  t-  r-  r-  Jt-  t-  r^  t- 1-  t- 

0 

Z 

>— lOlOtTHiOCOt-OOOSOt— lOl 

1— 1   T-(   I— 1 

1  6  5  S  o 
(ur7=  <u  rt  rt  5 

Zpazc/)cnZ 


6 
C.2 


b 
O    . 

2< 


62 

WW 


w 
o 


»0  Tf  lO  lO  »o  >o 
o  r-  o  or-  o 

C5  lO  0>  Ol  O  Oi 
1— 1  1— 1  r-(  1— 1  Ol  1— t 

d 

lO  Ol  »o  »0  1— <  "O 
t-  CD  r^  t—  OO  t^ 

o'  d  o  d  d  d 

Ol  Ol  00  1— t 

rH  I— I  i-H  CO 
01  Ol  01  Ol 


01  Ol  i-H  Ol  1— I  Ol 


Ol  Ol  01  Ol  Ol  Ol 


488 


APPENDIX. 


TABLE  XXIII. 

BRACHYCEPHALIC COLORED. 


x' 

Width  Out- 
side 1st 
Molar. 

Width  Out- 
side 2d 
Bicuspids. 

Width  Be- 
tween 2d 
Bicuspids. 

Antero-Pos- 

TERIOR. 

Height  of 
Vault. 

z 

In.    1    Mm. 

In. 

Mm. 

In. 

Mm. 

In 

Mm. 

55.37 
53.84 

56!  80 
57.15 
57.15 

In. 

Mm. 

1 

2 
3 
4 
5 
6 

87 
87 
85 
84 
84 
81 

2.87 
2.50 
2.37 
2.25 
2.50 
2.50 

72.90 
63.50 
60.20 
57.15 
63.50 
63.50 

2.00 
2.25 
2.00 
2.00 
2.12 
2.00 

50.80 
57 .  15 
50.80 
50.80 
53.84 
50.80 

1.31 
1.62 
1.37 
1.31 
2.50 
1.37 

33.27 
41.15 
34.77 
33.27 
63.50 
34.79 

2.18 
2.12 

2!66 

2.25 
2.25 

0.56 
0.50 
0.62 
0.75 
0.50 
0.75 

14.22 
12.70 
15.74 
19.05 
12.70 
19.05 

TABLE  XXIV. 

MESOCEPHALIC COLORED. 


Width  Out- 

Width Out- 

Width Be- 

Antero-Pos- 

Height  of 

• 

side  1st 

side  2d 

•a 

c 

Molar. 

Bicuspids. 

Bicuspids. 

z 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

1 

80 

2.50 

63.. 50 

2.25 

57 .  15 

1.62 

41.15 

2.31 

58.67 

0.62 

15.74 

?, 

79 

2.81 

71. 37 

2.50 

63.. 50 

1.62 

41.15 

2.25 

57.15 

0.62 

15.74 

3 

79 

2.25 

57 .  15 

2.00 

.50.80 

1..50 

38.10 

2.00 

50.80 

0.62 

15.74 

4 

78 

2.50 

63.50 

2.50 

63.50 

1.50 

38.10 

2.37 

60.20 

0.62 

15.74 

5 

78 

2.12 

.53.84 

1.50 

38.10 

1.31 

33.27 

2.12 

53.84 

0.62 

15.74 

6 

75 

2.37 

60.20 

2.00 

50.80 

1.37 

34.79 

0.50 

12.70 

TABLE  XXV. 

dolichocephalic COLORED. 


Width  Out- 

Width Out- 

Width Be- 

\ntero-Pos- 

Height  of 

side  1st 

side  2d 

tween  2d 

Vault 

•a 

c 

70 

Molar. 

Bicuspids. 

Bicuspids. 

z 

In. 

Mm. 

In. 

Mm 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

1 

2.12 

53.84 

1.87 

47.49 

1.18 

29.97 

2.18 

55.37 

0.56 

14.22 

•:> 

69 

2.50 

63.50 

2.12 

53.84 

1.50 

38.10 

2.25 

57.15 

0.62 

15.74 

3 

67 

2.50 

63.50 

2.18 

55.37 

1.50 

38.10 

2.25 

57 .  15 

0.62 

15.74 

4 

67 

2.25 

57.15 

2.00 

50.80 

1.18 

29.97 

2.25 

57.15 

0.62 

15.74 

5 

63 

2.25 

57.15 

2.12 

53.84 

1.50 

38.10 

2.25 

57.15 

0.62 

15.74 

6 

60 

2.50 

63*50 

2.25 

57.15 

1.75 

44.45 

2.37 

60.20 

0.68 

17.27 

TABLE  XXVI. 

BRACHYCEPHALIC,    AVERAGE WHITE    AND    COLORED. 


RACE. 


White . . 
Colored. 


Width  Out- 
side 1st 
Molar. 


In. 


2  22 
2.33 


Mm. 


56.38 
59.18 


Width  Out- 
side 2d 
Bicuspids. 


Width  In- 
side 2d 
Bicuspids. 


Antero-Pos- 

TERIOR. 


In. 


1.98 
2.06 


Mm. 


In. 


Mm. 


In. 


50.29 
52.32, 


1.19    30.22  I  2.16 
1.53    38.86    2.16 


Mm. 


54.86 
"54.86 


Height  of 
Vault 


In. 


0.54 
0.61 


Mm. 


13.71 
15.49 


.•\PrF.XDIX. 


489 


TABLE   XXVII. 


MESOCEPHALIC,    AVERAGE WHITE   AND  COLORED. 


RACE. 

Width  Out- 
side Isr 
Molar. 

Width  Out- 

SIDE2D 

Bicuspids. 

Width  In- 
side 2d 
Bicuspids. 

.AnteroPos- 

TERIOR. 

Height  of 
Vault. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

White.. 
Colored. 

2.21 
2.42 

56.13 
61.36 

1.95 
2.12 

48.53 

53.84 

1.16 
1.49 

29.47 
37.55 

2.18 
2.16 

55.37 

54.86 

0.52 
0.60 

13.20 

15.24 

TABLE  XXVIIL 


DOLICHOCEPHALIC,    AVERAGE WHITE  AND  COLORED. 


RACE. 

Width  Out- 
side 1st 
Molar. 

Width  Out- 
side 2d 
Bicuspids. 

Width  In- 
side 2d 
Bicuspids. 

Antero-Pos- 
terior. 

Height  of 
Vault. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

In. 

Mm. 

White. . 
Colored. 

2.19 
2.35 

55.62 
59.69 

1.97 
2.09 

50.03 

53.08 

1.50 
1.42 

38.10 
36.06 

2.18 
2.26 

55.37 

57.40 

0.74 
0.62 

18.79 
15.74 

The  following'  table  exhibits  the  differences  in  the  heights  of 
vaults  in  normal  and  defective  jaws.  The  height  is  taken  cen- 
trally and  vertically  from  the  gingival  plane  on  a  transverse  line 
intersecting  gingival  crests  between  the  second  bicuspids  and 
lirst  molars.  Fig.  24  shows  the  instrument  used,  and  the  man- 
ner of  making  the  measurements. 

TABLE   XXIX. 

NORMAL  JAW. 


Heigrhtof 

No.  of 

Height  of 

No.  of 

Height  of 

No.  of 

Heightof 

No.  of 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

.21 

1 

.40 

159 

.56 

936 

.71 

149 

.25 

2 

.43 

182 

.59 

218 

.75 

427 

.28 

70 

.46 

69     [ 

.62 

514 

.78 

69 

.31 

171 

.50 

199     I 

.65 

150 

.81 

(O 

.34 

169 

.53 

429 

.68 

568 

.84 

12 

.37 

146 

■■■     1 

Total  number  of  cases.  4,614.    Average,  .58  of  an  inch. 


490 


APPENDIX. 


TABLE  XXX. 

SADDLE-SHAPED    ARCH. 


Heigrhtof 

No.  of 

Heightof 

No.  of 

Heightof 

No.  of 

Heightof 

No.  of 

Vault; 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

.21 

.40 

.56 

(i 

.71 

5 

.25 

.43 

.59 

5 

.75 

5 

.28 

.46 

3 

.62 

4 

.78 

1 

.31 

.50 

5 

.65 

.81 

1 

.34 

.53 

5 

.68 

3 

.84 

.37 

1 

Total  number  of  cases,  44.    Average,  .GO  of  an  inch. 


TABLE   XXXL 


V-SHAPED    ARCH. 


Heightof 

No.  of 

Heightof 

No.  of 

Heightof 

No.  of 

Heightof 

No.  of 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

.21 

.40 

1 

.56 

15 

.71 

1 

.25 

.43 

.59 

4 

.75 

2 

.28 

.46 

3 

.62 

9 

.78 

.31 

>> 

.50 

8 

.65 

.81 

i 

.34 

.53 

3 

.68 

5 

.84 

.37 

4 

Total  number  of  cases,  58.    Average.  .55  of  an  inch. 


TABLE  XXXII. 


SEMI-V    AND    SEMI-SADDLE-SHAPED    ARCH. 


Heightof 

No.  of 

Height  of 

No.  of 

Heightof 

■  No.  of 

Heightof 

No.  of 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

Vault. 

Cases. 

.21 

.40 

.59 

1 

.75 

.25 

1 

.43 

1 

.62 

4 

.78 

i 

.28 

.46 

.65 

o 

.81 

.31 

.50 

3 

.68 

.84 

.34 

.53 

3 

.71 

9 

.37 

1 

.56 

5 

Total  number  of  cases,  24.    Average,  .56  of  an  inch. 


TABLE  XXXIII. 

Deformities    of    the    Jaws    Among    the    Degenerates    of    Europe. 
ATHENS  PRISON,  452  CONVICTS. 

V-shaped  arch    o 

Saddle-shaped  arch  o 

Arrest  of  the  lower  jaw Frequent. 

Recession  of  the  forehead Frequent. 

Irregular  relation  of  the  upper  and  lower  jaw.  ..  Very  common. 

Third  molars,  upper  and  lower Usually  present. 

Vault   Lower  than  average. 

IDIOTS    AND   INSANE,    GREEK   INSANE   HOSPITAL   IN    CON- 
STANTINOPLE, 332,  MALES  166,  FEMALES  166. 

V-shaped    arch i 

Saddle-shaped  arch  o 

Arrest  of  the  lower  jaw 48% 

Third  molars ." Normally  developed. 

IDIOTS  AND  INSANE,  ARMENIAN  INSANE  HOSPITAL,  CON- 
STANTINOPLE, 250  INMATES;  MALES  175,  FEMALES   75- 

V-shaped  arch    i 

Arrest  of  lower  jaw 18% 

Third  molars Normal. 

Third   molars    Many. 

IDIOTS  AND  INSANE,  VIENNA  INSANE  HOSPITAL, 
326  INMATES. 

V-shaped  arch   4 

Saddle-shaped  arch  i 

Third  molars Normal  311. 

MOSCOW  PRISON,  2,000  INMATES  (INFIRMARY,  247). 

Contracted  jaws O    . 

Irregularities  of  the  teeth 0 

Jaws  large  and  vaults  low All. 

MOSCOW  REFOR^I  SCHOOL.  112  BOYS. 

Partial  V-shaped  arches 3 

Saddle-shaped  arches  o 

Jaws  as  a  rule  large  and  broad,  with  low  vaults. 

MOSCOW  INSANE  HOSPITAL,  400  PATIENTS,  12  IDIOTS. 

Contracted  crches o 

Jaws  large  and  broad,  with  low  vaults. 

491 


492  APPENDIX. 

STOCKHOLM  INSANE  HOSPITAL,  270  PATIENTS. 

V-shaped  arches 6 

Partial    V-shaped    arches 12 

Semi  V-shaped  arches ". 4 

Saddle-shaped    23 

Partial  saddle-shaped   4 

Excessively  developed  upper  jaws 11 

Excessively  developed  under  jaws 3 

Hypertrophy  of  the  Alveolar  Process 9 

Missing  third  molars 42 

Missing  laterals  6 

Deformities  of  individual  teeth Numerous. 

STOCKHOLM  SCHOOL  OF  IDIOCY,  120  INMATES. 

80  40, 

Boys.  Girls. 

Normal    jaws    14  15 

V-shaped    12  i 

Partial    V-shaped    10  5 

Semi  V-shaped 4  5 

Saddle-shaped  8  8 

Partial  saddle-shaped  i  o 

Semi   saddle-shaped    2  i 

Hypertrophy  of  the  Alveolar  Process 32  14 

Macrocephalic    12  6 

Microcephalic    5  4 

One  boy  of  thirteen,  able  to  take  care  of  himself,  had  a  head  32  inches 
in  circumference. 

HAMBURG  PRISON,  1,800  INMATES. 

Large,  well  developed  jaws The  rule. 

Asymmetry  in  development Frequent. 

HAMBURG  SCHOOL  OF  IDIOCY,  600  INMATES. 

396  204 

Boys.  Girls. 

Normal  jaws 62  28 

V-shaped    12  4 

Partial  V-shaped  16  7 

Semi  V-shaped  8  3 

Saddle-shaped    4  i 

Partial  saddle  3  I 

Semi  saddle  2  3 

Hypertrophy   of  the   Alveolar    Process 46  25 

Macrocephalic  3  5 

Microcephalic    4  2 

One  boy  of  thirteen   had  a  Igwer  jaw  excessively  developed  one  and 
one-half  inches  beyond  the  normal  upper. 


APPENDIX.  493 

AMSTERDAM  INSANE  HOSPITAL,  1,330  INMATES. 

Contracted  arches   o 

Low  vaults    67 

Hypertrophy  of  the  Alveolar  Process Frequent. 

Missing  third  molars o 

AMSTERDAM  SCHOOL  OF  IDIOCY,  255  INMATES. 

116  139 

Boys.  Girls. 

V-shaped    i  i 

Partial  V-shaped  3  2 

Semi  V-shaped i  o 

Saddle  i  o 

Hypertrophy  of  the  Alveolar   Process 0  19 

Vaults  low  and  jaws  well  developed. 

PARIS  SCHOOL  OF  IDIOTS,  667  INMATES. 

500  167 

Boys.  Girls. 

V-shaped    i  i 

Partial  V-shaped  40  6 

Semi  V-shaped    2  i 

Saddle    2  8 

Partial  saddle   I  2 

Semi   saddle 4  i 

Hypertrophy  of  the  Alveolar  Process 7  4 

The  vaults  were  low. 

PARIS  PRISONS  (4),  INMATES  2,600. 
Deformities  of  the  jaw  not  obvious. 

BROADMORE  INSANE  HOSPITAL  (CRIMINALS). 
Marked  deformities  of  the  jaw  and  teeth  80  to  85%. 

HANWELL  INSANE  HOSPITAL,  2,080.     INSANE  AFTER 
MATURITY. 
Hypertrophy  of  the  Alveolar  Process  frequent. 
Excessive  and  arrested  development  of  the  jaws  frequent. 
Stigmata  of  degeneracy  the  rule. 

FLETCHER  BEACH  IDIOTS'  SCHOOL,  13  INMATES. 

V-shaped    3 

Partial  V-shaped  8 

Semi  V-shaped  i 

Hypertrophy  of  the  Alveolar    Process 6 

Notched  and  pitted    teeth 8 

High  vaults  13 

Laterals  missing    4 

These  patients  were  too  young  to  decide  as  to  number  of  third  molars. 


494 


APPENDIX. 


EARLSWOOD  IDIOT  SCHOOL,  670  INMATES. 

400  270 

Boys.  Girls. 

Normal  j  aws  31  24 

V-shaped  arch   108  67 

Partial  V-shaped  69  86 

Semi  V-shaped  11  24 

Saddle-shaped    19  8 

Partial  saddle-shaped  2"]  23 

Semi  saddle  13  i 

Marked  arrest  of  upper  jaw 104  87 

Marked  protrusion  of  upper  jaw 64  24 

Marked  protrusion  of  lower  jaw 11  i 

Marked  arrest  of  lower  jaw 306  237 

Lateral  incisors  arrested  46  30 

Lateral    incisors   lost 28  16 

Third  molars  lost   180  85 

Showed  malnutrition  of  teeth 160  78 

Cleft  palate   o  i 

DARENTH  SCHOOL,  IDIOT,  1,000  INMATES  (CHILDREN). 

640  360 

Boys.  Girls. 

Normal  jaws 150  90 

V-shaped  jaws 143  118 

Partial  V-shaped  jaws 140  80 

Semi  V-shaped  jaws 105  65 

Saddle  35  o 

Partial  saddle  20  8 

Semi  saddle 10  20 

Marked  arrest  of  upper  jaw 450  310 

Marked  protrusion  of  upper  jaw 150  90 

Marked  protrusion  of  lower  jaw 23  9 

Arrest  of  lower  jaw 600  340 

Lateral    incisors   arrested 68  2>2 

Lateral  incisors  lost 42  19 

Third  molars  lost  388  1 1 1 

Hypertrophy  of  upper  jaw   150  90 

SHUTTLEWORTH  SCHOOL  FOR  IDIOTS,    12  INMATES. 

Normal  j  aw  i 

V-shaped    2 

Partial  V-shaped   5 

Semi  V-shaped  i 

Partial  saddle  2 

Semi  saddle  I 

Hypertrophy  of  Alveolar  Process 4 

Notched  and  pitted  teeth 9 

High  vaults 12 

Third  molars  missing Patients  too  young  to  decide . 

Laterals  missing   S 


APPENDIX.  495 

DARENTH  ADULT  SCHOOL,  1,050  INMATES. 

450  600 

Males.  Females. 

Normal  jaws  60  40 

V-shaped   105  177 

Partial  V-shaped  93  121 

Semi   V-shaped   53  79 

Saddle   31  o 

Partial  saddle  5  8 

Semi  saddle o  10 

Marked  arrest  of  upper  jaw 295  436 

Marked  protrusion  of  upper  jaw 162  209 

Marked  protrusion  of  lower  jaw 8  17 

Arrest  of  lower  jaw 409  580 

Lateral    incisors   arrested 48  72 

Lateral  incisors  lost 37  62 

Third  molars  lost   442  597 

Hypertrophy  of  upper  jaw 58  36 

Of  the  children,  five  hundred  and  seventy-six  boys  showed  malnutri- 
tion in  utero;  two  hundred  and  eighty-two  girls  showed  malnutrition  in 
utero.  Of  the  adults,  three  hundred  and  ninety-six  males  showed  malnu- 
trition in  utero;  five  hundred  and  seventy-eight  females  showed  malnutri- 
tion in  utero. 

LANGDON  DOWN'S   IDIOT  SCHOOL,    147  INMATES. 

97  50 

Boys.  Girls. 

Normal   jaws    12  5 

V-shaped    36  10 

Partial  V-shaped  20  9 

Semi  V-shaped  15  12 

Saddle   9  7 

Partial  saddle  13  i 

Semi  saddle 28  16 

Arrest  of  upper  jaw 86  45 

Third  molars  missing 92  47 

Lateral  incisors  missing 16  8 

Teeth  showing  arrest  and  grooves 46  21 

Hypertrophy  of  the  Alveolar   Process 19  7 

Of  the  twelve  normal  arches  (males)  seven  were  hypertrophied.  Of 
the  five  normal  dental  arches    (females)    three  were  hypertrophied. 


ANTERO-POSTERIOR  AND  LATERAL 
ILLUSTRATIONS  OF  THE  VAULT 


33  -  497 


PLATE  1. 


5eve«  ycqr3  oPci^t 


498 


PLATE  2. 


5evcn  yeQrscfadc 
4" 


499 


500 


PLATE  4. 
B§ht"year5ofqge 


io 


IZ 


501 


PLATE  5. 


503 


PLATE  6. 

Mirf«  years  of  ag« 
15 


15 


17 


6fli? 


PLATE  7. 

~7en  yccit^  of  age 


504 


PLATE  8. 

Ten  yeqrs  of  ad« 


21 


505 


PLATE  9. 


CIcYcrr  vcar^  ot'q<^e. 


a<r 


30. 


507  J 


PLATE  11. 

Twelve  year^  of  ao'c. 


PLATE  12. 

Twelve  ye  qrs  of  a^c 


31 


32 


35 


54 


509 


PLATE  13. 

Brqcbyccfihqii'c.  White 


510 


PLATE  14. 

Bracfiycefiliql/c.  Wfiite. 


PLATE  IS. 

^rqcliycej-ifighc.    White. 


PLATE  16. 

BracfiycefrWic.  WfiiTe 


8 


PLATE  17. 


Mesocefihqiic.   WFtifc. 


514 


PLATE   18. 


Mes  oce/i  h  q  I  ic .  Wh  i  le 


PLATE  19. 

Mesocejrfiqljc.  White 


PLATE  20. 

Mesoccfihafic.  \^^h^tz 


If 


IZ 


617 


PLATE  21. 


DoIicliocehliQliC.   White 


PLATE  22. 

Dolichocefihal/c.  WfiiTe, 


PLATE   23. 


Brqchycc/ifiqlic.    Colored. 


520 


PLATE  24. 


J5>rqcfiyce[ihqlfc.  Colorc-q. 


5. 


6. 


521 


PLATE  25. 


MeaoccfiHcIic.  Colored- 


PLATE  26. 

Mesocefrhqlic.  Colored. 
"7 


PLATE  27. 


DotichocefihaJic.  Colored. 


524 


PLATE  28. 

Dolichoccfihalfc.  Cojorecj 


5. 


6. 


525 


PLATE  29. 

V  shqfiea  Vqulf. 


PLATE  30. 

V^jiqfied  Vault. 


527 


PLATE  31. 


Seini  Vshgjiecf  Vqult. 


528 


PLATE  32. 

5erni  Vshqfied  VoalT. 


35 


529 


PLATE  33. 


3q(fcflc-5hqfie4  VquWt. 


530 


PLATE  34. 

Saddle  sliajied  Vciixlt 


3. 


531 


PLATE  35. 

Semi  -  3qddlg   Vntrff 


632 


PLATE  36. 


6. 


533 


EXPLANATION  OF  PLATES. 


Plates  I  to  1 1  show  the  shape  of  the  teeth,  alveolar  process, 
and  vault  at  the  median  line. 

Plates  2  to  12  show  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar. 

Plates  13  and  15  illustrate  the  shape  of  the  teeth,  alveolar 
process  and  vault  at  the  median  line,  of  twelve  brachycephalic 
white  adults.  (For  measurements  of  these  cases  see  pages  486 
to  489.) 

Plates  14  and  16  illustrate  the  shape  of  the  teeth,  alveolar 
process  and  vault  at  a  line  drawn  laterally  anterior  to  the  first 
permanent  molar,  of  twelve  brachycephalic  white  adults. 

Plates  17  and  19  show  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line,  of  twelve  mesocephalic  white  adults. 

Plates  18  and  20  show  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molars  of  twelve  mesocephalic  white  adults. 

Plate  21  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  median  line  of  six  dolichocephalic  white  adults. 

Plate  22  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar  of  six  dolichocephalic  white  adults. 

Plate  23  shows  the  shape  of  the  teeth,  alveolar  process  and 
the  vault  at  the  median  line  of  six  brachycephalic  colored  adults. 

Plate  24  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  line  drawn  laterally  anterior  to  the  the  first  permanent 
molar  of  six  brachycephalic  colored  adults. 

Plate  25  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  the  median  line  of  six  mesocephalic  colored  adults. 

534 


EXPLANATION    OF    PLATES.  535 

Plate  26  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar  of  six  mesocephalic  colored  adults. 

Plate  27  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  the  median  line  of  six  dolichocephalic  colored  adults. 

Plate  28  shows  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar  of  six  doHchocephalic  colored  adults. 

Plate  29  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  V-shaped  vaults  of  white 
adults. 

Plate  30  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molars  of  six  V-shaped  vaults  of  white  adults. 

Plate  31  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  semi-V-shaped  vaults  of  white 
adults. 

Plate  32  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  dra\\Ti  laterally  anterior  to  the  first  permanent 
molars  of  six  semi-V-shaped  vaults  of  white  adults. 

Plate  33  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  the  median  line  of  six  saddle-shaped  vaults  of  white 
adults. 

Plate  34  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molars  of  six  saddle-shaped  vaults  of  white  adults. 

Plate  35  illustrates  the  shape  of  the  teeth,  alveolar  process  and 
vault  at  the  median  line  of  six  semi-saddle  shaped  vaults  of  white 
adults. 

Plate  36  illustrates  the  shape  of  the  teeth,  alveolar  process 
and  vault  at  a  line  drawn  laterally  anterior  to  the  first  permanent 
molar  of  six  semi-saddle  vaults  of  white  adults. 


INDEX  OF  AUTHORS. 


Aitken,  VV.,  98. 

Alexander,  Harriet  C.   B.,   ^iT,    128, 

141. 
Allen,  52. 

Allen,  H.,  172,   173,   189. 
Alvarez,  L.,  100. 
Andronico,   138,   141. 
Ansell,  22. 
Aristotle,  20. 
Arthur,  12. 
Austin.  J.  F..  457. 
Aubezi,  2. 
Awl,  108. 
Ayres,  H.,  208. 
Baas,   I. 

Baer,  Von,  20,  2>Z- 
Ballard,  T.,  4,  237. 
Bannister.  H.  M.,  99. 
Bauchwitz,  17. 
Baudelocque,  29. 
Beaunis,  291. 
Bell,  T.,  7. 
Berdmore,  5. 
Berwig,   no. 
Bigot,  29. 
Bjornson,  116. 
Black,  G.  v.,  87,  95,  467. 
Blake,  3. 

Blount,  A.  A.,  14. 
Bock,  210. 
Booth,  B.,  137. 
Borelius,  378. 
Bosworth,  175,  189. 
Bouchard,  291. 
Boullard,  235. 
Boyd,  29. 

Brideman,  W.  K.,  12. 
Brigham,  108,  135,   138. 
Broca,  45,  136. 
Bronzet,  380. 
Brown,  H.   H.,  257. 


Bruce.  210. 

Bruno,  2. 

Bulwcr,  120. 

Bunyan,    116. 

Bureau,  no. 

Calkins,   no. 

Campagne,    136. 

Camper,  153,  156. 

Canton,  A.,  12,  235.* 

Carpenter,  G.  T.,  376. 

Cartwright,  13,  14. 

Carver,  380. 

Catching,  380. 

Catlin,  9. 

Cazeaux,  29. 

Celsus,   I. 

Charrin,    120. 

Christopher,  W.  S.,  no. 

Clapp,  Dwight  M.,  399. 

Clark,  J.  P.,  n. 

Clarke,  A.,  10. 

Cloquets,  153. 

Clouston,   84.  238,    241.   j8o.   282. 

Cohnheim,  34. 

Cole.  Oakley,  65,  83,  i}^,  293.  294. 

Coleman,  14,  51. 

Columbus,  29. 

Colyer,  15. 

Conger,   100. 

Coolidge,  F.  S.,  120. 

Cravens,  J.  E.,  338. 

Crooke,  2,  3,  5,  10. 

Cuylitz,  237. 

Cuvier,  153. 

Dahn,    100. 

Dana,  C.  L..  296. 

Dareste,  25,  33,  209. 

Darwin,  C,  52.  378. 

Davenport,  342. 

Deah.  L.  W..  208,  212. 

Delabarre,  C.  F.,  13. 


537 


538 


INDEX    OF    AUTHORS. 


Demarquay,  294. 

DeMoor,  2^,  38,  119. 

Denniker,  100. 

DesChampes,  130. 

Despine,  135. 

Dickens,  C,  296. 

Dionis,  2. 

Dohrn,  36. 

Donatus,  M.,  29. 

Down,  J.  L.,  14,  loi,  130,  236,  238, 

292,  295. 
Dray,  A.  R.,  154. 
Duncan,  J.  M.,  22,  100. 
Duplay,  294. 
Durkheim,  96. 
Duval,  J.  R.,  13. 
Dwinell,  Wm.  H.,  440,  441. 
Ebers,  I. 
Ebner,  V.,  91. 

Ellis,  Havelock,  23,  30,  32,  93,  134. 
Erasistratus,  i. 
Etienne,  no. 
Farrar,  411,  436,  438. 
Fauchard,  2. 
Fere,  28,  211. 
Fitch,  S.  S.,  6. 

Fletcher,  M.   H.,  205,  206,  207. 
Flower,  44. 
Follin,  294. 
Folsom,  J.  R.,  209. 
Fournier,  E.,  122. 
Fox,  F.,  2,  379. 
Fox,  J.,  6. 
Frigerio,  142. 
Fuller,  J.,  10. 
Galen,  2. 
Gait,  135. 
Gardien,  29. 
Garriolt,  J.  B.,  6. 
Geddes,  18. 
Gegenbauer,  95. 
Ghimes,  9. 
Gihon,  105. 

Giovanni  de  Arcoli,  2. 
Gley,  120. 


Goddard,  Paul,  11. 

Goethe,  20. 

Gomme,  114. 

Gould,  29,  125,  214,  235,  380. 

Gray,  88. 

Grenser,  295. 

Grimaldi,  138,  141. 

Grohman,  135. 

Guilford.   S.   H.,   15,  2>77,  379,  396, 

397,  469- 
Gunnell,  13. 
Gurlt,  235. 
Hafner,  107. 
Haller,  29. 

Hammond,  W.  A.,  146. 
Hannover,  209. 
Harbert,   S.,  12. 
Harris,  C.  A.,  12. 
Harris,  E.,  136. 
Harris,  J.,  3. 
Haskell,  L.  P.,  221,  223. 
Hawley,  G.  F.,  257. 
Hepburn,  15. 
Herodotus,   i. 
Herzog,  M.,  418. 
Heyman,  113. 
Hildebrand,  O.,  379. 
Hippocrates,  i,  102. 
Hitchcock,   54. 
Hogden,   in. 
Hughes,  C.  H.,  135. 
Humphreys,  G.  M.,  7. 
Hunter,  7. 
Hutchinson,  J.,   124.    140,  371,   27^. 

379. 
Huxley,  T.  H.,  44. 
Imrie,  3,  237. 
Ivy,  R.  S.,  241,  244. 
Jacquarts,  153. 
James,  B.,  6  . 
Jobson,  D.  W.,  II. 
Kant,  41. 

Keane,  44,  102,  113. 
Keen,  W.  W.,  247,  291. 
Keith,  R.  P.,  154. 


INDEX    OF    AUTHORS. 


539 


Kells,  C.  Edward,  399,  400. 
Kiernan,  J.  G.,  22,  23,  26,  28,  33,  yj, 

99,    100,    loi,    108,    III,    113. 

114,   IIS,   132,   141,  211. 
Kingsley,   15,  228,  35s,   384,  44 1- 
Kirk,  E.  C,  235. 
Knecht,  295. 
Koecker,  7. 
KoUiker,  70. 
Kollman,  95. 
Kolster,  125. 
Korosi,  100, 
Kraft-Ebing,  143. 
Lagorio,  A.,  28. 
Laing,  115. 

Lane,  W.  Arbuthnot,   15. 
Landolt,  218. 
Langenbeck,  189,  235. 
Langenbuch,  293. 
Lankester,  R.,  36. 
Lazarus,  112. 
Lefoulon,  J.,  4. 
Lessert,  A.  A.  de,  5. 
Levison,  29. 
Lind,  J.,  106. 
Loeb,  J.,  38. 
Lombroso,  130,  138,  141. 
Loude,  C.  de,  9. 
Luys,  18. 

Lydston,  G.  P.,  225. 
Mackenzie,  J.,  172,  173,  189. 
Maclean,  M.,  8. 
Magalhaes,  129. 
Magill,  468. 
Magitot,  54,  95,  378. 
Magnan,  127. 
Mallan.  11. 
Manning.  99. 
Mantegazza,  116. 
Marie,  16. 
Marro,  loi. 
Marsh,  365,  366. 
Matthews,  W.,  10. 
Maurice,  235. 
Maury,  11. 
McCullom,  A.,  440,  441. 


M'Dowell,  J.  N.,  399,  401. 

Merrick,   138. 

Metschinkoff,  123. 

Meynert,  133. 

Mills,  C.  K.,  134. 

Milne-Edwards,  132. 

Minot,  40,  93,  291,  292. 

Mitchell,  A.,  22,  loi. 

Monteyel,  de,  99. 

Moreau,  de  Tours,  21,  22. 

Morgagni,  175,  178. 

Morgan,  de,  71. 

Morel,  142. 

Mortimer,  8. 

Muller,  Max,  115. 

Mummery,  14,  51,  52. 

Murphy,  J.,  6. 

Nasse,  125. 

Nasmyth,  5. 

Nessel,  9. 

Nicholas,  235. 

Nicholles,  8. 

Nichols,  14. 

Ogle,  295. 

O'Neill,  E.  F.,  155. 

Osbom,  36,  375. 

Osier,  125. 

Otis,  General,  106. 

Otto,   379. 

Palmer,  W.  €.,  154. 

Parmly,  6. 

Parrot,  140. 

Patterson,  W.  J.,  108. 

Pearsol,  W.  B.,  377. 

Petrie,  Flinders,  115. 

Phisalix,  210. 

Pierce,  88. 

Pinckard,   C.   P.,  211. 

Pliny,  29. 

Poole,  T.  C,  26. 

Porak,  III. 

Prenant,  235. 

Prichard,  135. 

Pruner  Bey,  103. 

Pyncheon,  257. 

Quatrefages,  103. 


540 


INDEX    OF    AUTHORS. 


Quelmalz,  174. 

Ray,  108,  135. 

Recklinghausen,   139. 

Rennert,   in. 

Ribot,  19. 

Robertson,  W.  C,  11. 

Robin,  95. 

Roller,  99. 

Rosser,  2>77- 

Ross,  H.  H.,  5. 

Roux,  294. 

Roux,  34. 

Royce,  136. 

Rush,  135. 

Ruspini,    7. 

St.  Hilaire,  20. 

Salter,   Thomas,  5. 

Saulle,  L  .de,  28. 

Sayce,  i. 

Schaus,  175. 

Scott,  C.  A.,  35. 

Scott,  Joseph,  8. 

Scott,  Sir  W.,  114. 

Schultz,  174. 

Schultze,   100. 

Semeleder,  172. 

Sergi,  86. 

Sewell,  H.,  14. 

Shakespeare.  W.,  2,  29. 

Sharpey,  87. 

Shaw,    Clay,   236. 

Sigmond,  10. 

Smith,  B.  Holly,  154. 

Soemmering,  29. 

Souques,    125. 

Spencer,    Herbert,   21,   22,   33. 

Spitzka,  E.  C,  25,  27,  144. 

Spooner,  8. 

Starr,  F.  W.,  103,  114. 

Steams,  H.  M.,  108. 

Stockton,  4. 

Strahan,  96,  97,  98. 


Sutton,  Bland,  292,  294,  295. 

Swieten,  Van,  29. 

Tanquerel,  des  Planches,  in. 

Tamowsky,   P.,    138,   141,  157,   295. 

Taylor,  114. 

Theile,  189. 

Thompson,  A.  H.,  365,  zTi,  381,  382. 

Thomson,   B.,   135. 

Thornton,  W.,  8. 

Thurman,  378. 

Tiedemann,  292. 

Tomes,  9,  53,  65,  68.  71,  235,  379. 

Topinard,  47,  115,  153. 

Touvet-Fanton,  378. 

Trelat,  294. 

Trendlenburg,  175. 

Tuke,  D.  H.,  96. 

Tyndall,  J.,   134. 

Valenta,  -22. 

Valerian,  29. 

Valude,  210. 

Verduc,  2. 

Virchow,  24,   148. 

Virgilus,   P.,  29. 

Vogt,  C,  103,  247. 

Volkmann,  70,  413.  414,  416,  417,  418. 

Waite,  G.,  6. 

Walker,  W.  E.,  154. 

Walther,  292. 

Weber,  M.  J.,  292. 

Weismann.  23,  24,  25,  102. 

Welcker,  17';,  247. 

White,  J.  W.,  5. 

Whitney,  J.  M.,  100,  173. 

Williams,  378. 

Wilson,  G.,   136. 

Winckworth,  J.,  3. 

Windle,  114. 

Workman,  100. 

Ziem,  193. 

Zuckerkandl,  172,  173,  174,  185. 


INDEX  OF  SUBJECTS. 


Aborigines,   155. 
Acromegaly,    16. 
Adenoids,    8,    10,    67,    79. 
Admixture,  113. 
Age, 

Mouth  and.  76,  78. 

Pregnancy  and,  22,  100. 

Surgical   Correction    and,    435, 
448. 

Vault  height  and,  81. 
Agn..thia,  235. 
Altitude,   106,   107. 
Alveolar  Process,  15,  52,  ^T,  ^%,  90, 
198,  273. 

Articulation,  65. 

Hypertrophy,  67. 

In  Idiots,  67. 

Irregularities,  69. 

Tropics,   106. 
Annelid,   208. 
Aniridia,    211. 
Anomalies,    148. 

Anthropoid    A.pes,    30,    155,    208. 
Antrum,  177,  185.  191,  194,  196,  198, 

200,  202,  218. 
Appliances,  427. 
Arch,  74. 

Dental,  83. 

V-shaped,  297,  299,  301. 

Widening,  74. 
Areori,   100. 
Aryan,  113,  115. 
Ascidian,  208. 
Atavism,   19,  21,   -^Z- 
Beloides,   86. 
Bicuspids,  323. 

Extraction  of,  342. 
Births,  Multiple,  100. 
Bleeders,  125. 
Body  Plasm,  24. 


Bone  Changes  in  Jaw,  406. 

Brachycephaly,  45. 

Brachygnathia,  235. 

Brain  Development,  38. 

Canaliculi,  73. 

Causes   and   Predispositions,    148. 

Cephalic  Index,   155. 

Child  not  an  Immature  Adult,  30. 

Promise  Non-Fulfillment,  31. 
Chondrocranium,  40,  93. 
Climate,  102. 
Colobomia,  211. 
Congenital   Factors,   27. 
Concrescence,  94,  372. 
Consanguinity, 

Natural,  96. 

Social,  96. 
Constitutional  Diseases,  120. 
Contagions  and  Infections,   120. 
Correction,    Elastic    Rubber,    439. 

Metals  in,  454. 

Traction  in.  439. 

Surgical.  427,  431. 
Corectopia,  211. 

Cranio-Mandibular   Index,   155. 
Criminals,   134. 
Crowns  Flattened,  zil- 
Crown  Teeth  Changes,  59. 
Cuspids,  323. 
Cyclopia,  208,  210. 
Deaf  Mutes,  214. 

Degeneracy,   19,   21,   ZZ,  35,  37.  47, 
121,  200. 

Disease,  204,  206.  208. 

Ear,  138,  141,  214. 

Eye,  171,  208. 

Hawaiian,   100. 

Palate,  236,  238,  240. 

Operations  in,  203. 

Stigmata,  198,  200,  202. 


541 


542 


INDEX    OF    SUBJECTS. 


Dental  Index,  94. 

Ligament,  87. 

Shelf,  93. 
Dentistry, 

Assyrian,  i. 

Chinese,  i. 

Egyptian,  i. 

Etruscan,  2. 

Hindoo,  i. 

Hippocrates,  i. 

Shakespeare,  2. 
Dentures,  224,  239. 
Dermal  Bones,  40. 
Development, 

Arrested,  20,  21. 

Brain,  38. 

Excessive,  20. 

Face,   40. 

Jaws,  48. 

Mouth,  41. 

Nose,  41. 

Peridental  Membrane,  87. 

Tooth,  93. 

Skull,  40. 

Suppressive,  20. 

Vault,  74. 
Diet,  Monotony  of,  108. 
Differentiation  Theory,  374. 
Diphyodontia,  93. 
Disease  and  Jaw  Arrest,  79. 
Dogs'  Gingivitis,  410. 
Dolichocephaly,  55,  75,  155. 
Dome,  74. 

Duck  Bill,  Teeth  of,  382. 
Drug  Habitues,  137. 
Ductless  Glands,  121. 
Durencephaly,  127. 
Edentates,  93. 
Edentulousness,   378. 
Ellipsoides,  86. 
Enamel,  381. 

Organs,  94. 
Environment,  102. 

Organs  Change,  38. 
Epilepsy,   109,   112,    121,   130,   133. 

Alveolar    Process,   67. 


Teeth  Eruption  in,  68. 
Eurygnathism,  46. 
Eustachian  Tube,  290. 
Exanthemata,  14,  16. 
Exogamy,  96. 
Eye, 

Degeneracy,  211. 

Development,  208. 

Lemurian,  208. 
Face, 

Developmental  Neuroses,  153. 

Origin  of,  44. 

Senile,   166. 

Type  of,  385- 
Facial  Angle,  47,  153,  154,  155. 
Families,  Large,  23. 
Foetus, 

Life  of,  31. 

Sensation  in,  28. 
Food  and  Jaw  Changes,  54,  102. 
Forces, 

Correction   in,   431. 

Mechanical,  429,  443. 
Function,    Assimilation    and,    35. 
Genius,  130. 
Germ   Plasm,  24. 
Gingivitis,  Interstitial,  385,  431. 

In  Dogs,  410, 
Gnathism,  46. 
Gomphosis,  59. 
Haemophilia,  125. 
Halisteresis,  410. 
Hare-lip,  292. 
Haskell  Jaw,  223. 
Haversian    Canals,    70. 
Hawaii, 

Degeneracy  in,  172. 

Race  Admixture,  172. 
Hawaiians,  Degeneracy  in,    100. 
Heart  Development,   38. 
Hemiagnathia,  235. 
Heredity, 

Direct,  19,  23,  26. 

Habit,  24. 

Indirect,  19. 

Jaw,  55,  84,  119. 


INDEX    OF    SUBJECTS. 


543 


Remote,  18. 

Sex  in,  18. 

Telegenic,   19. 

Tooth,  84.  119- 

Transformed,  18,  21,  24,  98. 
Hysterics,    130,    132. 
Idiot, 

Palate,  236. 

Savants,  127. 

Vault,  236. 
Idiocy,  Mouth-breathing  and,  67. 
Idiosyncrasy,  Tension  in,  92. 
Imbeciles,  Moral,  128,  I43- 
Impression  Taking,  389. 
In-and-In  Breeding,  96. 
Incest,  96. 
Incisor,  323,  325. 
"Indian"  Change    in    the    Yankee, 

103. 
Individuation,   22. 
Inebriates,   137. 
Intellectual  Defects,  127. 
Invertebrates,  208. 
Iris  Asymmetry,  211. 
Irregularity  Correction,     383,     385, 

387. 
Time  of,  385.  387- 
Jaw, 

Age  and,  76. 
Arrest  of,  38,  99,  170. 
Asymmetry,  219,  224,  226. 
Bone  Changes  in,  406. 
Close  Fitting,  80. 
Contour,  220. 
Deformity,  235. 
Degeneracy,  216. 
Diameter  of,  47,  49,  5i- 
Disuse,  53,  151.  * 

Dogs  in,  151. 
Evolution  of,  155,  367. 
Excessive  Bone  Growth,  216. 
Foods  and,  54,  117.  216. 
Haskell,  223. 
Hypertrophy,  217. 
In  Normal  People,  215. 


Irregular  Growth,  7,  9,  11,  14. 

383,  385. 

Lower,  219,  222,  231. 
"    Absorption,  433,  435- 

Muscles  and,  218. 

Narrow,  83. 

Neuroses  of,  215. 

Orthognathous,  153. 

Prognathous,  153. 

Protrusion  of,  231. 

Recession  of,  155. 

Small  Tooth  Great,  il. 

Teeth  and,  222. 

Tobacco  Chewing  and,  216. 

Upper,  182,  219,  222,  297. 
Kahunas,  100. 
Kava-Kava,  100. 
Lacimae,  72. 
Mammals, 

Oviparous,  93. 

Teeth  of,  93. 
Marriage, 

Early,  96. 

Late,  96. 

Near-kin,  96. 
Mastication  Motion,  224. 
Maternal  Impressions,  26. 
Maxillaries,  41. 
Megadontia,  94. 
Mesodontia,  94. 
Metals  in  Correction,  454. 
Microdontia,  94. 
Microphthalmus,  211. 
Models,  Wire  in,  391,  393- 
Modeling  Compound,  389,  391,  393- 
Molar  Teeth,  52,  370. 

Extraction  of,  340,  342. 

First  Permanent,  323,  335,  337. 

339- 
Temporary,  323. 
Mouth, 

Age  and,  76,  78. 

Breathing,   8,  67,   79,   182,    196, 

249,  251,  253. 
Origin  of,  41. 


544 


INDEX    OF     SUBJECTS. 


Roof  of,  74. 

Vault  of,  74. 
Moral   Insanity,   120. 
Multiple   Births,   22. 
Myolonia,  208. 
Nares  External,  290. 
Negroes, 

Facial  Angle,   153. 

Jaws,  155. 

Mesocephaly,   155. 

Prognathism,  155. 
Neuroses,  172. 

Cavity,  180,  192. 

Degeneracy,  191. 

Fracture  at  Birth,  193. 

Puberty  and,  172. 

Septum,  172,  193. 

"      Deformity,  175,  177. 
"      Fracture,  176. 
Length,  178. 
Neurotics,  130,  132. 
Neuroticism,   157. 
Nose, 

Embryology,  290. 

Degeneracy,  139. 

Development,  172,  191. 

Origin  of,  41,  43. 
Notochord,  41. 
Nymphomania,  143. 
Occlusion,  389,  391,  39'. 
Odontogogues,  i. 
Organs,   Struggle    Between,   20,   33, 

34- 
Orbits, 

Anthropoid  Ape,  171. 

Arrest  of,  171. 

Lemurian,  171. 
Orthognathism,  46. 
Osteomalacia,  418. 
Ovoides,  86. 
Palate, 

Cleft,  292,  294,  296. 

Contracted   Vaults   and.   292. 

Degeneracy,  236,  238,  240. 

Developmental  Neuroses,  290. 

Embryology,  291. 


Hard,   74. 

Horizontal  Plates,  74. 

Incisive  Plates,  74. 

Idiot,  236. 

Irregularity,  4,  6.  14,  16.  • 

Lower  Jaw  and,  290. 

Olfactory  Nerve  and,   292. 

Plates,  74. 

Soft,  .75. 

Shelves,  250. 

Temperament,  241,  243. 
Paranoia,  128,  144. 
Parents, 

Immature,   100. 

Senile,  loi. 
Paris,  Plaster  of,  389. 
Pathology  or  Nosology,   148. 
Pathologic  Changes,  405. 
Paupers,  136. 
Pellagra,    108. 
Pentagoides,  86. 

Peridental   Membrane.  60,  87,  91. 
Periods  of  Stress,  23,  37,  38,  66,  TJ, 

149. 
Pessimism,  129. 

Philippines,   Americans   in,    106. 
Physiologic  Changes,  405. 
Pineal  Body,  209. 
Poisoning, 

Brass,  iii. 

Carbon,  Bisulphide,  in. 

Lead,  iii. 

Mercury,  iii. 

Phosphorus,   in. 
Polyphyodontia,  93. 

In  Man,  379. 
Pregnancy, 

Age  and,  22,  100. 

Brass   Poisoning   and.    111. 

Diet  and  Offspring,  no. 

Infection  and,  120. 

Lead  Poisoning  and,   ni. 

Multiple,  100. 

Opium  Habitues,  no. 

Phosphorus  and,    in. 

Plural,  22. 


INDEX    OF    SUBJECTS. 


545 


Tobacco  Workers,  no. 

Too  Frequent,  lOO. 

Strain  During,  149. 
Primitive  Races,  Teeth  of,    14. 
Prognathism,  46. 
Prostitutes,  137. 
Race, 

Admixture,  14,  lor. 

Climate  and,  102. 

Egyptian,  115. 

English  Speaking,  103,  105,  115. 

Hebrew,   115. 

Indian,   115. 

Scandinavian.   116. 

Scotch-Irish,  112. 

Teeth  and,  94. 

Tropic,  105. 

Types,   113. 

Vault  and,  246.  248. 
Rachitis,  216. 
Reasoning   Maniacs,   146. 
Regulation, 

Fees  from,  386,  388,  402. 

Time  of,  383,  385,  387. 
Rickets,   121. 

Rubber  in  Correction,  439. 
Salernum,  School  of,  2. 
School  Strain,  386.  388. 
Scrofula,  217. 
Scurvy,  212. 
Senescence,  29,  31,  ;i^. 
Senile  Intra-Uterine     Period,     123, 

125- 

Tendency,  31. 
Senility,   Premature,   166. 
Sexual   Perverts,   143. 

Strain,  386. 
Shakespeare  on  Dentistry.  2. 
Shearing  Teeth,  3. 
Skiagraph,  Use  of.  399. 
Skull, 

Dryness,  173. 

Evolution  of,  40. 

Kant,  41. 

Median,  74. 

36 


Roman,  2. 
Types,  45. 

Degenerate,  138. 
Sergi's,  55. 
Vault  and,  246,  248. 
Soil,  102. 

Stress,   Periods  of,  23.  37. 
Stigmata,  Frequency  of,  170. 
Struggle  Between  Organs,  20,  2^,  34. 
Supernumerary  Teeth,  3. 
Suppressive   Economy,  382. 
Surgical  Diagnosis,  383. 
Suture,  Frontal.  41,  74. 
Syphilis,  122,  216. 
Teeth, 

Altitude  and,   107. 

Antagonism,  64. 

Bicuspid,  58. 

Calcification,  56. 

Canine,  57. 

Civilization   and,    151. 

Choice  in  Removal,  396,  398. 

Cone-shaped,  369. 

Contagions  and,   122. 

Constitutional  Disease  and,  272. 

Correction  Forces  Needed,  431. 

Crown  Changes,  59. 

Cuspid,   58. 

Decay  of,  54. 

Deciduous,  385. 

Deformed,  371. 

Degenerate,    140,   362,   364,   366, 
368.  370,  372. 

Development.  93. 

Domestication  and,  151. 

Drilling,  432. 

Embryology  of,  362. 

Eruption,  464, 

Epilepsy  in,  63. 

Extraction,    5,    7,    9,    78.    150. 

Finger  Sucking  and,  358,  360. 

Food  and,  150. 

Four  Sets  of,  380. 

Hairless  Dogs,  378. 

Hairiness  and,  378. 

Heredity,   119. 


546 


INDEX    OF    SUBJECTS. 


Horny,  382. 

Hutchinson's,  123.  371. 

Incisor,  57. 

In  Dogs,  151- 

Irregularities,  67,   69.   383,   385- 

Lower  Jaw  and.  223. 

"     Irregularities.     344.     346, 
348,  350,  352,  356. 
Mammalian,  93. 
Measurements  of,  49,  51. 
Molar,  52. 
Permanent,  4,  7,  9,  57.  61.  150. 

323- 
Pits  in.  123. 
Position  Change.  66. 

"     Neuroses,  297,  299,  301. 
Primitive  Race,  14. 
Protrusion  and,  227. 
Race  and.  94.  151. 
Reptilian,  93. 

Sacrifice  of,  392,  394,  396,  398- 
Senility  in,  380. 
Shearing    3. 
Stomach  and,  58. 
Supernumerary.  3.  5.  7.  366.  379. 

381. 
Temperature,  102. 
Temporary.  4,  6,  8,  57,  60.  150, 

323- 
Third  Molars,  52. 
Thumb-Sucking,  3.  57.  227,  236. 
Tobacco  and  Offspring,  110. 
Tonsils    Enlarged,    5.   7,   8,    10. 
Traction  in  Correction.  439. 
Tramps,  137. 
Triophthalmia,  208. 
Trophic  Change,  16. 


Tropho-neuroses.  372. 

Tropics  and,  106. 

Turbinated  Bones.  172.  177,  186, 
190,  192.  196. 

Upper  Jaw  Irregularity,  323. 
325,  Z'^l,  329,  331,  333,  335. 
ZZ7,  339- 

Vault  and,  279. 

Whales  in,  93. 

Worm  in,  i. 
Telegony,  19. 
Temperaments,   241.  243. 
Trapezoides,   86. 
Uvula,  76,  291,  296. 

Degenerac}'.  296. 

In  Thieves,  296. 
Vault, 

Contracted,  85. 

Degenerate,  85. 

Development,  74. 

Height.  80.  82.  84, 

Low,  85. 

Mouth-breathing  and,  249,  251, 

253- 

Neuroses,  236. 

Neurotic,  84. 

Race  and,  246,  248. 

Septum  and,  177. 

Skull  and.  246,  248. 
Vegetarians,  Degeneracy  in.  108. 
Volkmann's  Canals.  70. 
Vomer.  74,   174,   178.   181,   184.    188, 

190,  192,  194,  240,  279,  292. 
Von  Ebner's  Vessels,  70. 
Weismannism,  23,  102,  149. 
Wurtemburgers  Georgian,   102. 


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